Minimal fluoroscopy approach for right-sided supraventricular tachycardia ablation with a novel ablation technology: insights from the multicenter CHARISMA clinical registry.

BACKGROUND No data exist on the ability of the novel Rhythmia 3-D mapping system to minimize fluoroscopy exposure during transcatheter ablation of arrhythmias.We report data on feasibility and safety of a minimal fluoroscopic approach using this system in supraventricular tachycardia (SVT) procedures. METHODS Consecutive patients were enrolled in the CHARISMA registry at 12 centers. All right-sided procedures performed with the Rhythmia mapping system were analyzed. The acquired electroanatomic information was used to reconstruct 3-D cardiac geometry; fluoroscopic confirmation was used whenever deemed necessary. RESULTS 325 patients (mean age=56±17years, 57% male) were included: 152 AVNRT, 116 AFL, 41 and 16 right-sided accessory pathway and AT, respectively. Overall, 27481 seconds of fluoroscopy were used (84.6±224sec per procedure, equivalent effective dose=1.1±3.7mSv per patient). 192 procedures (59.1%) were completed without the use of fluoroscopy (zero fluoroscopy, ZF). At multivariate analysis the presence of a fellow in training (OR=0.15, 95%CI:0.05 to 0.46; p=0.0008), radiofrequency application (0.99, 0.99 to 1.00; p=0.0002) and mapping times (0.99, 0.99 to 1.00; p=0.042) were all inversely associated to ZF approach. Acute procedural success was achieved in 97.8% of the cases (98.4 vs 97% in the ZF vs non-ZF group, p=0.4503). During a mean of 290.7±169.6days follow-up, no major adverse events were reported, and recurrence of the primary arrhythmia was 2.5% (2.1 vs 3% in the ZF vs non-ZF group, p=0.7206). CONCLUSIONS The Rhythmia mapping system permits transcatheter ablation of right-sided SVT with minimal fluoroscopy exposure. Even more, in most cases, the system enables a ZF approach, without affecting safety and efficacy. This article is protected by copyright. All rights reserved.