ablation is the treatment of choice for most forms of SVT. Traditionally,
fluoroscopy has been the primary tool for visualizing catheter position.
However, newer, 3-dimensional mapping technologies offer multiple options for
minimizing fluoroscopy use. We review our 8 year experience of a
zero-fluoroscopy approach using the Ensite system, and discuss our current
Methods: From January
2006 to October 2013, we performed 524 catheter ablation procedures with a
zero-fluoroscopy approach. The Ensite system was used exclusively. Early in the
study, NavX mode was employed. In the later time period, Velocity mode was
used. The Ensite system allowed easy access to all right sided arrhythmias. For
left sided arrhythmias, TEE was added to aid with transseptal puncture.
Results: Reviewing 524
consecutive procedures, mean age was 14 years (range 7 weeks to 65 years). Mean
weight was 60.7 kg (range 3 to 174 kg). Mean procedure time was 142 minutes
(range 42 – 402 minutes). There were no complications. Twenty -five patients
required the use of fluoroscopy, mostly as part of simultaneous diagnostic or
interventional cath procedures. There was only one instance in which
fluoroscopy was used when not anticipated at the start of the procedure. With
this data available, and seeing that fluoroscopy is rarely needed unexpectedly,
we hypothesized that catheter ablation no longer requires a traditional cath
lab. We present our early approach to ablation outside the catheterization lab.
dimensional mapping systems can eliminate fluoroscopy use in virtually all
routine ablation procedures. As technology improves, ablation procedures will
shift beyond the traditional cath lab.
Credits: Amee M. Bigelow, MD; Grace Smith, MD; John M. Clark, MD