Antonio Pani1, Belotti Giuseppina1, Carlo Bonanno1, Maria Grazia Bongiorni1, Nicola Bottoni1, Roberta Brambilla1, Sergio de Ceglia1, Paolo Della Bella1, Giovanni de Vito1, Daniele Malaspina1, Endrj Menardi1, Velia Napoli1, Maria Silvia Negroni1, Salvatore Ocello1, Daniela Orsida1, Claudio Pandozi1, Stefano Pedretti1, Diego Penela1, Patrizia Pepi1, Luca Rossi1, Giovanni Rovaris1, Alice Scopinaro1, Antonello Vincenti1, Graziana Viola1, Valerio Zacà1, Franco Zoppo1, Pasquale Vergara1. 1. From the Cardiology Department, Ospedale Alessandro Manzoni, Lecco, Italy (A.P., R.B., G.d.V.); Cardiology Department, Ospedale Treviglio e Caravaggio, Italy (G.B.); Cardiology Department, Ospedale San Bortolo, Vicenza, Italy (C.B.); Cardiology Department, Ospedale Cisanello, Azienda Ospedalieria Universitaria, Pisa, Italy (M.G.B.); Cardiology Department, Ospedale Santa Maria Nuova, Reggio Emilia, Italy (N.B.); Cardiology Department, Ospedale San Gerardo, Monza, Italy (S.d.C., G.R.); Arrhythmology Unit and Electrophysiology Laboratories, Ospedale San Raffaele, Milano, Italy (P.D.B., P.V.); Cardiology Department, Ospedale San Carlo Borromeo, Milano, Italy (D.M.); Cardiology Department, Ospedale ASO S. Croce e Carle, Cuneo, Italy (E.M.); Johnson & Johnson Med, Biosense Webster Italy, Milano (V.N.); Cardiology Department, Ospedale San Paolo, Milano, Italy (M.S.N.); Cardiology Department, Ospedale Santissima Trinità, Cagliari, Italy (S.O.); Cardiology Department, Ospedale S. Antonio Abate, Gallarate, Italy (D.O.); Cardiology Department, Ospedale San Filippo Neri, Roma, Italy (C.P.); Cardiology Department, A.S.S.T Grande Ospedale Metropolitano Niguarda, Milano, Italy (S.P.); Cardiology Department, Ospedale Guglielmo da Saliceto, Piacenza, Italy (D.P., L.R.); Cardiology Department, Ospedale San Carlo Poma, Mantova, Italy (P.P.); Cardiology Department, Azienda Ospedaliera SS. Antonio e Biagio, Alessandria, Italy (A.S.); Cardiology Department, Ospedale Multimedica, Sesto San Giovanni, Italy (A.V.); Cardiology Department, Ospedale San Francesco, Nuoro, Italy (G.V.); Cardiology Department, Ospedale Santa Maria alle Scotte, Siena, Italy (V.Z.); and Cardiology Department, Ospedale Civile, Mirano, Italy (F.Z.).
Abstract
BACKGROUND: This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias. METHODS AND RESULTS: Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (r=-0.112; P=0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (P=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (P=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (P=0.002) and patient's age (P=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases. CONCLUSIONS: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.
BACKGROUND: This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias. METHODS AND RESULTS: Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (r=-0.112; P=0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (P=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (P=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (P=0.002) and patient's age (P=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases. CONCLUSIONS: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.
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