ZERO OR NEAR ZERO FLUOROSCOPY CATHETER ABLATION OF PREMATURE VENTRICULAR CONTRACTIONS: A MULTICENTRE EXPERIENCE

Background: Catheter ablation has become an established treatment option for premature ventricular complexes (PVCs). It is well known that the use of fluoroscopy exposes patients and medical staff to potentially harmful stochastic and deterministic effects of ionising radiations. We sought to analyse procedural outcomes in terms of safety and efficacy using a “zero or “near zero X rays approach for treatment of PVCs. Methods: The present retrospective, multicentre, observational study included 131 patients having undergone catheter ablation of PVCs using zero or “near zero (less than 2 minutes) fluoroscopy between 2016 and 2020 in 4 high-volume centres. Baseline characteristics of the population, acute success and complications derived from the procedure were evaluated, as well as recurrence rate during follow-up. Results: Median age was 51.0 years old [38-63], males were 77 (58.8%). Most often cause of ablation were palpitations (90.0%), followed by reduced left ventricular ejection fraction (4.6%) and pre-syncope (14.5%). Among the study population, 26 (19.8%) had a cardiopathy. The median PVC burden before ablation was 15.1% [6%-22.4%]. The most frequent PVC origin was right ventricular outflow tract (n=72; 55.0%) followed by the left ventricle (n=21; 16.0%), LVOT and cusps (n=18; 13.7%), aortomitral continuity (n=7; 5.3%). A 3D electro-anatomical mapping system was used in all cases as well as a contact force catheter for mapping and ablation. The mean maximum radiofrequency power applied was 32.9 ± 4.1 W (median time: 370 sec). Median number of applications was 4.5 and mean total procedural time was 117.3 ± 47.5 minutes. Median best prematurity was 31.5 msec. We used isoprenaline in order to induce PVCs in 42% of cases and suppression of PVC was achieved in 127 patients (96.9%). There was only 2 complication (femoral hematoma and arteriovenous fistula conservatively treated). At 12 months, a complete success was documented in 109 patients (83.2%), a reduction in PVC burden was achieved in other 18 patients (13.7%) and a failure was recorded in 4 patients (3.1%). Conclusion: The PVC ablation with “zero or “near-zero fluoroscopy is a safe procedure with no major complications and good rates of success and recurrence in our multicentre experience..