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Abstract
Background Over the past decade, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) has evolved into a frequently performed procedure. The aim of this study was to monitor changes in patient characteristics, procedural characteristics, outcomes and complications over the past 10 years. Methods All consecutive patients who underwent primary RFCA treatment of AF in the University Medical Center Utrecht from 2005–2015 were included. In all patients, the primary ablation strategy was pulmonary vein (PV) antrum isolation without additional substrate modification. Baseline patient and procedure characteristics, and 1‑year follow-up data of 975 patients were prospectively collected. Results In 2005, 73.4% of patients suffered from paroxysmal AF, which decreased to 45.3% in 2014. Mean age increased from 54 ± 9 to 61 ± 10 years and CHA2DS2-VASc score ≥2 from 18 to 40.6%. History of AF decreased significantly from 7 to 4 years. Mean procedure duration was 237 ± 53 min in 2005 and 163 ± 41 min in 2014. Fluoroscopy time significantly decreased from 41 ± 17 to 19 ± 8 min and total radiation exposure from 465 (263–687) to 210 (118–376) mGy. One-year success remained similar (2005: 55.6%, 2014: 54.8%), as did the amount of PV reconnection observed during redo procedures. Due to a marked reduction in vascular complications and moderate PV stenosis, the total complication rate decreased significantly. Conclusion Over the past decade, AF ablation has increasingly been performed in older patients with persistent AF and more comorbidity. Moreover, it has been performed earlier after AF diagnosis. Although several performance parameters, such as procedure duration and complication rate, improved, 1‑year single procedure success remained unchanged.
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Cano Ó, Andrés A, Osca J, Alonso P, Sancho-Tello MJ, Olagüe J, Martínez-Dolz L. Safety and Feasibility of a Minimally Fluoroscopic Approach for Ventricular Tachycardia Ablation in Patients With Structural Heart Disease: Influence of the Ventricular Tachycardia Substrate. Circ Arrhythm Electrophysiol 2016; 9:e003706. [PMID: 26850881 DOI: 10.1161/circep.115.003706] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We sought to evaluate the safety and feasibility of a minimally fluoroscopic approach using the CARTOUNIVU module during scar-related ventricular tachycardia (VT) ablation. METHODS AND RESULTS Consecutive patients with structural heart disease undergoing VT ablation using the CARTOUNIVU module were prospectively included and classified depending on their VT substrate: (1) ischemic VT (IVT) and (2) nonischemic VT and depending on the presence of an epicardial access. Radiation exposure parameters and major and minor procedure-related complications were registered. A near-zero fluoroscopy exposure was defined as those procedures with an effective dose ≤1 mSv. A total of 44 VT ablation procedures were performed in 41 patients (22 IVT and 19 nonischemic VT). The use of the CARTOUNIVU module resulted in low levels of radiation exposure: median total fluoroscopy time and effective dose of 6.08 (1.51-12.36) minutes and 2.15 (0.58-8.22) mSv, respectively. Patients with IVT had lower radiation exposure than patients with nonischemic VT (total fluoroscopy time, 2.53 [1.22-11.22] versus 8.51 [5.55-17.34] minutes; P=0.016). Epicardial access was associated with significantly higher levels of radiation exposure. Complications occurred in 4.9% patients, none of them being related to the use of the image integration tool. A near-zero fluoroscopy ablation could be performed in 14 of 44 procedures (32%), 43% of IVT procedures, and 50% of procedures with endocardial access only. CONCLUSIONS The use of the CARTOUNIVU module during scar-related VT ablation resulted in low levels of radiation exposure. A near-zero fluoroscopy approach can be achieved in up to half of the procedures, especially in IVT patients with endocardial ablation.
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Affiliation(s)
- Óscar Cano
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.).
| | - Ana Andrés
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.)
| | - Joaquín Osca
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.)
| | - Pau Alonso
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.)
| | - María-José Sancho-Tello
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.)
| | - José Olagüe
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.)
| | - Luis Martínez-Dolz
- From the Section of Electrophysiology, Department of Cardiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain (O.C., A.A., J.O., P.A., M.-J.S.-T., J.O., L.M.-D.); and Instituto Investigación Sanitaria La Fe, Valencia, Spain (A.A., P.A.)
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CANO ÓSCAR, ALONSO PAU, OSCA JOAQUÍN, ANDRÉS ANA, SANCHO-TELLO MARÍAJOSÉ, OLAGÜE JOSÉ, SALVADOR ANTONIO, MARTÍNEZ-DOLZ LUIS. Initial Experience with a New Image Integration Module Designed for Reducing Radiation Exposure During Electrophysiological Ablation Procedures. J Cardiovasc Electrophysiol 2015; 26:662-70. [DOI: 10.1111/jce.12659] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 02/25/2015] [Accepted: 03/01/2015] [Indexed: 11/29/2022]
Affiliation(s)
- ÓSCAR CANO
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Instituto Investigación Sanitaria La Fe; Valencia Spain
| | - PAU ALONSO
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Instituto Investigación Sanitaria La Fe; Valencia Spain
| | - JOAQUÍN OSCA
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ANA ANDRÉS
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
- Instituto Investigación Sanitaria La Fe; Valencia Spain
| | - MARÍA-JOSÉ SANCHO-TELLO
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - JOSÉ OLAGÜE
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - ANTONIO SALVADOR
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
| | - LUIS MARTÍNEZ-DOLZ
- Electrophysiology Section, Cardiology Department; Hospital Universitari i Politècnic La Fe; Valencia Spain
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