Zero‐fluoroscopy ablation in patients with cardiac electronic implantable devices.

Introduction: Utilizing a three‐dimensional (3‐D) mapping system and intracardiac echocardiography (ICE) has allowed ablation procedures with less or without fluoroscopy; however, there is limited data for patients with cardiac electronic implantable device (CIED) leads regarding the suspected risk of lead injury. Therefore, we sought to explore technics to perform safe trans‐septal approach and catheter manipulation technique in patients with CIED leads. Methods and Results: This study comprised 49 consecutive patients (59% males, median 73 years old) with CIED who underwent catheter ablation for supraventricular tachycardia requiring the trans‐septal approach, 15 without fluoroscopy (zero‐fluoro group), and 34 with fluoroscopy (conventional‐fluoro group), between July 2019 and April 2021. All procedures were performed under a 3‐D mapping system and ICE guidance. We compared the differences in treatment and development of complications between the two groups. The procedures were for atrial fibrillation (82%) and atrial tachycardia (76%). Coronary sinus catheter insertion and the trans‐septal procedure were successfully performed in all patients. The median time from venipuncture to trans‐septal procedure (zero‐fluoro vs. conventional‐fluoro group: 28 [18–37] min vs. 24 [21–31] min, p =.70), total procedure time (231 [142–274] min vs. 175 [163–225] min, p =.63), and the acute procedural success rate (100% vs. 97%, p = 1.00) did not differ between both groups. No patient showed lead‐related complications in both groups. Conclusion: This is the first study to show zero‐fluoro ablation for supraventricular arrhythmia using 3‐D mapping and ICE in patients with CIED leads was feasible under careful catheter manipulation. [ABSTRACT FROM AUTHOR]

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