Dávid Kamilla Luca, Polgár Balázs, Bógyi Péter, Bári Zsolt, Marczell István, Bogdan Manuella, Gulyás Zalán, Turáni Mirjam Franciska, Papp Judit, Zsigmond Előd János, Tóth-Zsámboki Emese, Duray Gábor Zoltán
Department of Cardiology, Central Hospital of Northern Pest-Military Hospital, Budapest, Hungary.
Doctoral School of Clinical Medicine, Cardiovascular Medicine and Research Division, Semmelweis University, Budapest, Hungary.
Front Cardiovasc Med. 2025 Jul 10;12:1582753. doi: 10.3389/fcvm.2025.1582753. eCollection 2025.
Zero-fluoroscopy (ZF) catheter ablation eliminates radiation exposure via use of 3-dimensional electroanatomical mapping. We aimed to assess safety and efficacy of ZF catheter ablation in the treatment of supraventricular tachycardias (SVTs), examine learning-curve characteristics and to evaluate long-term results and mortality.
We analysed clinical characteristics, procedural and follow-up data of 605 consecutive patients undergoing catheter ablation for SVT (atrioventricular nodal re-entry tachycardia, = 297; atrial flutter, = 241 and accessory pathway mediated tachycardia, = 67) between June 2017 and September 2021. Procedures were either guided by conventional fluoroscopy (F, = 223) or by EnSite Precision mapping system (ZF, = 382) based on decision of the operating physician.
Acute procedural success rate exceeded 98% across all arrhythmia groups for both ZF and F techniques (ZF: 99%, F: 100%, = NS). 63% of patients underwent ZF procedures. Complication rate was low (0.66%), occurring only in the F group. Conversion rate to fluoroscopy was 7.8%. ZF procedures took an average of 5.1 min longer (ZF: 64.5 ± 24.3 min vs. F: 59.4 ± 29 min, < 0.05), however ZF procedure times were reduced over time. At 3.2 years, total mortality was 7% with no significant difference between ZF and F. Deaths were not related to the procedures. Atrial flutter showed significantly higher recurrence in ZF compared to F (83% vs. 94%, < 0.005).
Catheter ablation of SVTs using zero-fluoroscopy approach have similar acute success, complication and mortality rate as conventional fluoroscopic interventions. However, we detected significantly higher long-term arrhythmia recurrence after ZF ablation of atrial flutter, meriting further investigation.
零荧光透视（ZF）导管消融术通过使用三维电解剖标测技术消除了辐射暴露。我们旨在评估ZF导管消融术治疗室上性心动过速（SVT）的安全性和有效性，研究学习曲线特征，并评估长期结果和死亡率。
我们分析了2017年6月至2021年9月期间连续605例接受SVT导管消融术（房室结折返性心动过速，n = 297；心房扑动，n = 241；旁路介导的心动过速，n = 67）患者的临床特征、手术及随访数据。手术由操作医师决定，分别采用传统荧光透视（F，n = 223）或EnSite Precision标测系统（ZF，n = 382）引导。
对于ZF和F技术，所有心律失常组的急性手术成功率均超过98%（ZF：99%，F：100%，P = 无显著差异）。63%的患者接受了ZF手术。并发症发生率较低（0.66%），仅发生在F组。荧光透视转换率为7.8%。ZF手术平均耗时多5.1分钟（ZF：64.5±24.3分钟 vs. F：59.4±29分钟，P<0.05），然而ZF手术时间随时间减少。在3.2年时，总死亡率为7%，ZF和F之间无显著差异。死亡与手术无关。与F相比，ZF组心房扑动的复发率显著更高（83% vs. 94%，P<0.005）。
使用零荧光透视方法进行SVT导管消融术与传统荧光透视干预具有相似的急性成功率、并发症和死亡率。然而，我们检测到ZF消融心房扑动后长期心律失常复发率显著更高，值得进一步研究。
