Fluoroscopy-free catheter ablation for right-sided accessory pathways: Feasibility, safety, and outcomes.

BACKGROUND

Catheter ablation (CA) with guidance using fluoroscopy and electroanatomic mapping (EAM) is the standard and most effective treatment for atrioventricular accessory pathways (AP). However, data on fluoroscopy-free CA with AP remains limited.

AIMS

This study evaluated the feasibility of performing CA without fluoroscopy guidance, using only EAM, in patients with right-sided AP.

MATERIAL AND METHODS

We retrospectively included 100 consecutive patients with pre-excitation in ECG who underwent CA for right-sided AP. All procedures were performed using EAM. The primary outcome was the feasibility of performing the AP CA without the use of fluoroscopy. Secondary outcomes included the acute and long-term success rate, complications, and procedure time.

RESULTS

In 74 patients, the procedure was completed without fluoroscopy (ZF-EAM group), while 26 patients required fluoroscopy during the procedure (F-EAM group). Acute procedural success was achieved in 91% of patients overall, with a higher rate in the ZF-EAM group (72 of 74; 97%) compared to the F-EAM group (19 of 26; 73%) (P <0.001). After follow-up, long-term recurrence was observed in 6 of 72 patients (8.3%) in the ZF-EAM group and none of the 19 patients (0%) in the F-EAM group (P = 0.34). The procedure duration was shorter in the ZF-EAM group (median 1.3 hours [0.9-1.8]) compared to the F-EAM group (median 1.8 hours [1.3-2.6]; P = 0.007). No major complications occurred in either group.

CONCLUSIONS

CA of right-sided AP, guided entirely by EAM without the use of fluoroscopy, is feasible in most cases. This approach was associated with high efficacy and safety, and it may reduce procedure times.