Arshneel Kochar1, Taha Ahmed1, Eoin Donnellan1, Oussama Wazni1, Patrick Tchou1, Roy Chung2,3. 1. Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 33100 Cleveland Clinic Blvd, Avon, OH, 44011, USA. 2. Section of Cardiac Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 33100 Cleveland Clinic Blvd, Avon, OH, 44011, USA. chungr@ccf.org. 3. , 9500 Euclid Ave, Cleveland, OH, 44195, USA. chungr@ccf.org.
Abstract
PURPOSE: To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy. METHODS: This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve. RESULTS: A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p < 0.0001). PVI procedure time was 170 ± 34 min after 60 cases from 235 ± 41 min initially (p 0.001). Six out of 77 (8%) had AF recurrence at 12 months. CONCLUSIONS: Zero fluoroscopy ablation for AF, SVT, and PVC can be safely achieved without increasing procedure time. The steepest learning curve occurs over the first 20, 15, and 40 cases for SVT, PVC, and PVI ablation respectively.
PURPOSE: To investigate the learning curve for atrial fibrillation (AF), supraventricular tachycardia (SVT), and premature ventricular contraction (PVC) radiofrequency ablation (RFA) using zero fluoroscopy. METHODS: This is a retrospective, single-center study of 167 patients undergoing ablation between 2016 and 2019. Minimal fluoroscopy approach was initiated after the first 20 cases of PVI and SVT RFA. Procedures were divided consecutively into increments of 10 cases to determine operator learning curve. RESULTS: A total of 64 (38%) had SVT ablations, 26 (16%) had PVC ablations, and 77 (46%) had AF and underwent PVI. For SVT RFA, fluoroscopy time improved from 4.1 ± 3.5 min during the first 10 cases to 0.8 ± 1.2 min after 50 cases (p = 0.0001). Sixty-two out of 64 (97%) of cases were successful. In PVC RFA, fluoroscopy time was 7.7 ± 5.5 min for the first 5, 2.3 ± 3.4 min after 15, and 0 min after 20 cases (p = 0.0008). Twenty-four out of 26 (92%) of cases were acutely successful with recurrence in 2/26 (8%) of patients over 9 ± 9 months. In PVI, fluoroscopy time was 9.9 ± 3.3 min over the first 20 cases, 2.6 ± 2.3 min after 40 cases, and 0.1 min after 50 cases (p < 0.0001). PVI procedure time was 170 ± 34 min after 60 cases from 235 ± 41 min initially (p 0.001). Six out of 77 (8%) had AF recurrence at 12 months. CONCLUSIONS: Zero fluoroscopy ablation for AF, SVT, and PVC can be safely achieved without increasing procedure time. The steepest learning curve occurs over the first 20, 15, and 40 cases for SVT, PVC, and PVI ablation respectively.
Entities:
Keywords:
Electroanatomic mapping; Learning curve; Zero fluoroscopy ablation
Authors: Donald S Rubenstein; Benjamin B Holmes; Joseph A Manfredi; Matthew S McKillop; Peter C Netzler; Chad C Ward Journal: J Interv Card Electrophysiol Date: 2022-03-08 Impact factor: 1.759