Vol 25, No 3 (2018)
Original articles — Interventional cardiology
Published online: 2017-06-12

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Safety and efficacy of cryoablation without the use of fluoroscopy

Edward Kozluk1, Dariusz Rodkiewicz1, Agnieszka Piątkowska1, Grzegorz Opolski1
Pubmed: 28612907
Cardiol J 2018;25(3):327-332.

Abstract

Background: Development of electroanatomical systems make it possible to perform ablations without the use of fluoroscopy. The aim of this study was to evaluate the efficacy and safety of cryoablation pro­cedures without the use of fluoroscopy.

Methods: The study group consisted of 45 patients (14 female; age 36 ± 15 years) treated with cry­oablation using the EnSite electroanatomical system: 10 with ventricular extrasystoly from the right ventricle, 6 with the arrhythmogenic site near the left coronary artery, 17 patients with Wolff-Parkinson- -White syndrome (WPW), 2 patients with atrioventricular nodal reentrant tachycardia (AVNRT) type 2, 7 patients with AVNRT type 1, 3 patients with atrial tachycardia.

Results: In 38 of the 45 patients (84%) cryoablation procedure was performed without the use of fluoroscopy. Cryoablation efficacy was 78.9%. In 5 patients unsuccessful cryoablation was fallowed by radiofrequency applications. Finally, efficacy reached 92.1%. There were no deaths. In 1 patient a small adverse event — right bundle branch block was observed after ablation of para-Hisian accessory path­way. No other adverse events were observed. In the long term follow-up efficacy was 89.5%.

Conclusions: Cryoablation using electroanatomical system without the use of fluoroscopy is a safe and efficient procedure and it is a possible alternative in most patients qualified for cryoablation.

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References

  1. Picano E. Informed consent and communication of risk from radiological and nuclear medicine examinations: how to escape from a communication inferno. BMJ. 2004; 329(7470): 849–851.
  2. Picano E, Vañó E, Rehani MM, et al. The appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology. Eur Heart J. 2014; 35(10): 665–672.
  3. Hirshfeld JW, Balter S, Brinker JA, et al. ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. Circulation. 2005; 111(4): 511–532.
  4. Bigelow AM, Arnold BS, Padrutt GC, et al. Non-fluoroscopic cardiac ablation of neonates with CHD. Cardiol Young. 2017; 27(3): 592–596.
  5. Szumowski L, Szufladowicz E, Orczykowski M, et al. Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol. 2010; 21(8): 877–882.
  6. Stec S, Krynski T, Baran J, et al. "Rescue" ablation of electrical storm in arrhythmogenic right ventricular cardiomyopathy in pregnancy. BMC Cardiovasc Disord. 2013; 13: 58.
  7. Koźluk E, Piątkowska A, Kiliszek M, et al. Catheter ablation of cardiac arrhythmias in pregnancy without fluoroscopy: A case control retrospective study. Adv Clin Exp Med. 2017; 26(1): 129–134.
  8. Kozluk E, Tokarczyk M, Kozłowski D, et al. Radiofrequency catheter ablation during pregnancy. Folia Cardiol. 2005; 12(5): 338–342.
  9. Andreassi MG, Sagliano I, Cioppa A, et al. Chronic low-dose radiation exposure from interventional cardiology procedures induces chromosomal abnormalities in originally genetically identical twins. Int J Cardiol. 2007; 118(1): 130–131.
  10. Beels L, Bacher K, De Wolf D, et al. Gamma-H2AX foci as a biomarker for patient X-ray exposure in pediatric cardiac catheterization: are we underestimating radiation risks? Circulation. 2009; 120(19): 1903–1909.
  11. Beels L, Bacher K, Smeets P, et al. Dose-length product of scanners correlates with DNA damage in patients undergoing contrast CT. Eur J Radiol. 2012; 81(7): 1495–1499.
  12. Tuzcu V. A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system. Pacing Clin Electrophysiol. 2007; 30(4): 519–525.
  13. Casella M, Dello Russo A, Pelargonio G, et al. Rationale and design of the NO-PARTY trial: near-zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias in young patients. Cardiol Young. 2012; 22(5): 539–546.
  14. Miyamoto K, Tsuchiya T, Narita S, et al. Radiofrequency catheter ablation of ventricular tachyarrhythmia under navigation using EnSite array. Circ J. 2010; 74(7): 1322–1331.
  15. Sporton SC, Earley MJ, Nathan AW, et al. Electroanatomic versus fluoroscopic mapping for catheter ablation procedures: a prospective randomized study. J Cardiovasc Electrophysiol. 2004; 15(3): 310–315.
  16. Casella M, Pelargonio G, Dello Russo A, et al. "Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX™ mapping system: personal experience and review of the literature. J Interv Card Electrophysiol. 2011; 31(2): 109–118.
  17. Pachón M, Arias MA, Castellanos E, et al. No fluoroscopy for cavotricuspid isthmus-dependent right atrial flutter ablation. Heart Rhythm. 2009; 6(3): 433–434.
  18. Álvarez M, Tercedor L, Herrera N, et al. Cavotricuspid isthmus catheter ablation without the use of fluoroscopy as a first-line treatment. J Cardiovasc Electrophysiol. 2011; 22(6): 656–662.
  19. Ruiz-Granell R, Morell-Cabedo S, Ferrero-De-Loma A, et al. Atrioventricular node ablation and permanent ventricular pacemaker implantation without fluoroscopy: use of an electroanatomic navigation system. J Cardiovasc Electrophysiol. 2005; 16(7): 793–795.
  20. Earley MJ, Showkathali R, Alzetani M, et al. Radiofrequency ablation of arrhythmias guided by non-fluoroscopic catheter location: a prospective randomized trial. Eur Heart J. 2006; 27(10): 1223–1229.
  21. Stec S, Sledź J, Mazij M, et al. Feasibility of implementation of a "simplified, No-X-Ray, no-lead apron, two-catheter approach" for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol. 2014; 25(8): 866–874.
  22. Koźluk E, Gawrysiak M, Piątkowska A, et al. Radiofrequency ablation without the use of fluoroscopy - in what kind of patients is it feasible? Arch Med Sci. 2013; 9(5): 821–825.
  23. Mühl A, Kühne M, Sticherling C, et al. Fluoroscopy-Free PVI With nMARQ(TM) in a Patient With a PFO. J Cardiovasc Electrophysiol. 2015; 26(8): 906.
  24. Bulava A, Hanis J, Eisenberger M. Catheter Ablation of Atrial Fibrillation Using Zero-Fluoroscopy Technique: A Randomized Trial. Pacing Clin Electrophysiol. 2015; 38(7): 797–806.
  25. Yang Li, Sun Ge, Chen X, et al. Meta-analysis of zero or near-zero fluoroscopy use during ablation of cardiac arrhythmias. Am J Cardiol. 2016; 118(10): 1511–1518.
  26. Koźluk E, Piątkowska A, Rodkiewicz D, et al. Direct results of a prospective randomized study comparing ablation with the nMARQ catheter and the PVAC catheter used with and without a 3D system (MAPER 3D Study). Arch Med Sci. 2017.
  27. Koźluk E, Gawrysiak M, Lodziński P, et al. The LocaLisa system as the key to shortening the procedure duration and fluoroscopy time during ablation of atrial fibrillation. Kardiol Pol. 2008; 66(6): 624–629; discussion 630.