Long-Term Outcomes of Near-Zero Radiation Ablation of Paroxysmal Supraventricular Tachycardia: A Comparison With Fluoroscopy-Guided Approach.
catheter ablation
electroanatomic mapping system
minimally fluoroscopic approach
near-zero fluoroscopy
supraventricular arrhythmia
Journal
JACC. Clinical electrophysiology
ISSN: 2405-5018
Titre abrégé: JACC Clin Electrophysiol
Pays: United States
ID NLM: 101656995
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
08
12
2020
revised:
16
02
2021
accepted:
17
02
2021
pubmed:
3
5
2021
medline:
29
10
2021
entrez:
2
5
2021
Statut:
ppublish
Résumé
This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications. Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking. This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications. A total of 618 patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA. CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
Sections du résumé
OBJECTIVES
This study aimed to assess the long-term outcomes of minimally fluoroscopic approach (MFA) compared with conventional fluoroscopic ablation (ConvA) in terms of recurrences of arrhythmia and long-term complications.
BACKGROUND
Catheter ablation (CA) of supraventricular tachycardia (SVT) with an MFA, under the guidance of electroanatomic mapping (EAM) systems, results in a significant reduction in exposure to ionizing radiations without impairing acute procedural success and complication rate. However, data regarding long-term outcomes of MFA compared with ConvA are lacking.
METHODS
This is a retrospective observational study. All patients undergoing MFA CA of SVT (atrioventricular nodal re-entrant tachycardia and atrioventricular re-entrant tachycardia) between 2010 and 2015 were enrolled and were compared with matched subjects (1 MFA: 2 ConvA) undergoing ConvA during the same period. The 2 co-primary outcomes were recurrence of arrhythmias and long-term complications.
RESULTS
A total of 618 patients (mean age 38 ± 15 years, 60% female) were enrolled. MFA included 206 patients, whereas 412 were treated with ConvA. Acute success (99% vs. 97%; p = 0.10) and acute complications (2.4% vs. 5.3%; p = 0.14) were similar in the 2 groups. During a median follow-up of 4.4 years, 5.9% of patients experienced recurrence of arrhythmias. At multivariate analysis, ConvA (hazard ratio [HR]: 3.03) and procedural success (HR: 0.10) were independently associated with recurrence of arrhythmias. Late complications (i.e., advance atrioventricular block and need for pacemaker implantation) occurred more frequently in ConvA (3.4% vs. 0.5%; p = 0.03) compared with MFA.
CONCLUSIONS
CA guided by EAM systems with MFA provided better long-term results and reduced risk of complications compared with ConvA.
Identifiants
pubmed: 33933407
pii: S2405-500X(21)00201-2
doi: 10.1016/j.jacep.2021.02.017
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1108-1117Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Dr Dello Russo has received consulting fees and honoraria from Biosense Webster. Dr Di Biase is a consultant for Biosense Webster, Boston Scientific, Stereotaxis, Rhythm Management, and Abbott Medical Inc.; and has received speaking honoraria from Medtronic, Pfizer, Bristol Myers Squibb, and Biotronik. Dr Natale is a consultant for Biosense Webster, Abbott Medical Inc., and Janssen; and has received speaking honoraria from Boston Scientific, Biosense Webster, Abbott Medical Inc., Biotronik, and Medtronic. Dr Tondo has received consulting fees and honoraria from Abbott Medical Inc., Medtronic, Boston Scientific, and Biosense Webster; and serves as a member of EU Medtronic Advisory Board and Boston Scientific Advisory Board. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.