AUTHOR=Troisi Federica , Guida Pietro , Quadrini Federico , Di Monaco Antonio , Vitulano Nicola , Caruso Rosa , Orfino Rocco , Cecere Giacomo , Anselmino Matteo , Grimaldi Massimo 

TITLE=Zero Fluoroscopy Arrhythmias Catheter Ablation: A Trend Toward More Frequent Practice in a High-Volume Center

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.804424

DOI=10.3389/fcvm.2022.804424

ISSN=2297-055X

ABSTRACT=Background: Awareness of radiations exposure risks associated to interventional cardiology procedures is growing. Availability of new technologies in electrophysiology laboratories has allowed to reduce fluoroscopy usage during arrhythmias ablations. The aim of this study was to describe procedures with and without X-Rays and to assess feasibility, safety and efficacy of zero fluoroscopy intervention in a high-volume center oriented to keep exposure to ionizing radiation as low as reasonably achievable.
Methods: Cardiac catheter ablations performed in our hospital since January 2017 to June 2021.
Results: A total of 1853 procedures were performed with 1957 arrhythmias treated. Rate of fluoroless procedures was 15.4% (285 interventions) with an increasing trend from 8.5% of 2017 to 22.9% of first semester 2021. The most frequent arrhythmiatreated was atrial fibrillation (646; 3.6% fluoroless) followed by atrioventricular nodal reentrant tachycardia (644; 16.9% fluoroless), atrial flutter (215; 8.8% fluoroless), ventricular tachycardia (178; 17.4% fluoroless), premature ventricular contraction (162; 48.1% fluoroless) and accessory pathways (112; 31.3% fluoroless). Although characteristics of patients and operative details were heterogeneous among treated arrhythmias, use of fluoroscopy did not influence surgical time. Moreover, feasibility and efficacy were 100% in fluoroless ablations while the rate of major complications was very low and not different with and without fluoroscopy (0.45% vs 0.35%).
Conclusions: Limiting the use of X-Rays is necessary especially when the available technologies allow a zero approach. A lower radiation exposure may be reached reducing fluoroscopy usage whenever possible during cardiac ablation procedures with high safety, full feasibility and efficacy.