Nonfluoroscopic catheter ablation of tachyarrhythmias in patients with antiarrhythmic devices

Aim. To assess safety and effectiveness of zero fluoro catheter ablation (CA) of tachyarrhythmias in patients with antiarrhythmic device.

Methods. One hundred ninety-seven patients with implanted antiarrhythmic device and indication for catheter ablation of tachyarrhythmias were included in retrospective study. In control group of patients n=63 (mean age 65.5±11.9 years) all procedures were performed under fluoroscopic guidance. In a study group, n=134 (mean age 66.1±15.6 years) all procedures were performed without the use of fluoroscopy. To reconstruct 3D anatomy we used navigation systems: magnet and impedance. In some cases we used intracardiac ultrasound. In the first group there were 65% of patients with pacemakers, 4.8% patients with implantable cardioverters-defibrillators and 30.2% of patients had cardiac resynchronization systems. In second 70.1%, 12.7% and 17.2% respectively. In control group CA was performed within 24 hours after device implantation in 13 patients (20.6%), in study group - 23 (17.2%). In the rest cohort of patients mean period between device implantation and CA was 29.26±28 months - in control group, 38.8±39 months. Antiarrhythmic device programming was performed before and right after CA.

Results. Interventional catheter procedure was performed in 98.4% of patients in control group and in 98.5% of patients in study group. Radiation exposure in control group was 0.24 mZv, in study group 0 mZv. There were no conversions from zero fluoroscopy procedure to X -ray controlled due to different reasons. In control (fluoroscopy controlled) group 8 hours after CA ventricle lead dislodgement was diagnosed. Antiarrhythmic device in this patient was implanted 6 days before CA. There were no lead dislodgements or cardiac pacing disorders in study group.

Conclusion. Zero fluoroscopy CA of tachyarrhythmias in patients with antiarrhythmc device is as safe and effective as standard fluoroscopy controlled procedure.

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