Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience

Antonio Pani; Belotti Giuseppina; Carlo Bonanno; Maria Grazia Bongiorni; Nicola Bottoni; Roberta Brambilla; Sergio de Ceglia; Paolo Della Bella; Giovanni de Vito; Daniele Malaspina; Endrj Menardi; Velia Napoli; Maria Silvia Negroni; Salvatore Ocello; Daniela Orsida; Claudio Pandozi; Stefano Pedretti; Diego Penela; Patrizia Pepi; Luca Rossi; Giovanni Rovaris; Alice Scopinaro; Antonello Vincenti; Graziana Viola; Valerio Zacà; Franco Zoppo; Pasquale Vergara

doi:10.1161/CIRCEP.117.005592

Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience

Antonio Pani, Belotti Giuseppina, Carlo Bonanno, Maria Grazia Bongiorni, Nicola Bottoni, Roberta Brambilla, Sergio de Ceglia, Paolo Della Bella, Giovanni de Vito, Daniele Malaspina, Endrj Menardi, Velia Napoli, Maria Silvia Negroni, Salvatore Ocello, Daniela Orsida, Claudio Pandozi, Stefano Pedretti, Diego Penela, Patrizia Pepi, Luca RossiGiovanni Rovaris, Alice Scopinaro, Antonello Vincenti, Graziana Viola, Valerio Zacà, Franco Zoppo, Pasquale Vergara

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias.

METHODS AND RESULTS: Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (r=-0.112; P=0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (P=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (P=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (P=0.002) and patient's age (P=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases.

CONCLUSIONS: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.

Original language	English
Pages (from-to)	e005592
Journal	Circulation: Arrhythmia and Electrophysiology
Volume	11
Issue number	3
DOIs	https://doi.org/10.1161/CIRCEP.117.005592
Publication status	Published - Mar 2018
Externally published	Yes

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Pani, A., Giuseppina, B., Bonanno, C., Grazia Bongiorni, M., Bottoni, N., Brambilla, R., Ceglia, S. D., Della Bella, P., Vito, G. D., Malaspina, D., Menardi, E., Napoli, V., Negroni, M. S., Ocello, S., Orsida, D., Pandozi, C., Pedretti, S., Penela, D., Pepi, P., ... Vergara, P. (2018). Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience. Circulation: Arrhythmia and Electrophysiology, 11(3), e005592. https://doi.org/10.1161/CIRCEP.117.005592

Pani, A, Giuseppina, B, Bonanno, C, Grazia Bongiorni, M, Bottoni, N, Brambilla, R, Ceglia, SD, Della Bella, P, Vito, GD, Malaspina, D, Menardi, E, Napoli, V, Negroni, MS, Ocello, S, Orsida, D, Pandozi, C, Pedretti, S, Penela, D, Pepi, P, Rossi, L, Rovaris, G, Scopinaro, A, Vincenti, A, Viola, G, Zacà, V, Zoppo, F & Vergara, P 2018, 'Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience', Circulation: Arrhythmia and Electrophysiology, vol. 11, no. 3, pp. e005592. https://doi.org/10.1161/CIRCEP.117.005592

@article{1e806e54348c4e9fa16c8cb9dfac8a0a,

title = "Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience",

abstract = "BACKGROUND: This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias.METHODS AND RESULTS: Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (r=-0.112; P=0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (P=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (P=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (P=0.002) and patient's age (P=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases.CONCLUSIONS: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.",

author = "Antonio Pani and Belotti Giuseppina and Carlo Bonanno and {Grazia Bongiorni}, Maria and Nicola Bottoni and Roberta Brambilla and Ceglia, {Sergio de} and {Della Bella}, Paolo and Vito, {Giovanni de} and Daniele Malaspina and Endrj Menardi and Velia Napoli and Negroni, {Maria Silvia} and Salvatore Ocello and Daniela Orsida and Claudio Pandozi and Stefano Pedretti and Diego Penela and Patrizia Pepi and Luca Rossi and Giovanni Rovaris and Alice Scopinaro and Antonello Vincenti and Graziana Viola and Valerio Zac{\`a} and Franco Zoppo and Pasquale Vergara",

note = "{\textcopyright} 2018 American Heart Association, Inc.",

year = "2018",

month = mar,

doi = "10.1161/CIRCEP.117.005592",

language = "English",

volume = "11",

pages = "e005592",

journal = "Circulation: Arrhythmia and Electrophysiology",

issn = "1941-3149",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

TY - JOUR

T1 - Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience

AU - Pani, Antonio

AU - Giuseppina, Belotti

AU - Bonanno, Carlo

AU - Grazia Bongiorni, Maria

AU - Bottoni, Nicola

AU - Brambilla, Roberta

AU - Ceglia, Sergio de

AU - Della Bella, Paolo

AU - Vito, Giovanni de

AU - Malaspina, Daniele

AU - Menardi, Endrj

AU - Napoli, Velia

AU - Negroni, Maria Silvia

AU - Ocello, Salvatore

AU - Orsida, Daniela

AU - Pandozi, Claudio

AU - Pedretti, Stefano

AU - Penela, Diego

AU - Pepi, Patrizia

AU - Rossi, Luca

AU - Rovaris, Giovanni

AU - Scopinaro, Alice

AU - Vincenti, Antonello

AU - Viola, Graziana

AU - Zacà, Valerio

AU - Zoppo, Franco

AU - Vergara, Pasquale

PY - 2018/3

Y1 - 2018/3

N2 - BACKGROUND: This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias.METHODS AND RESULTS: Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (r=-0.112; P=0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (P=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (P=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (P=0.002) and patient's age (P=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases.CONCLUSIONS: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.

AB - BACKGROUND: This multicenter, prospective study evaluated the determinants of zero-fluoroscopy (ZFL) ablation of supraventricular tachycardias.METHODS AND RESULTS: Four hundred thirty patients (215 male, 55.4±22.1 years) with indication to electrophysiological study or ablation of supraventricular tachycardias were enrolled. All participating physicians agreed to follow the as low as reasonably achievable policy. A procedure was defined as ZFL when no fluoroscopy was used. The total fluoroscopy time inversely correlated to the number of procedures previously performed by each operator since study start (r=-0.112; P=0.02). Two hundred eighty-nine procedures (67.2%) were ZFL; multivariable analysis identified as predictors of ZFL: procedure after the 30th for each operator, compared with procedures up to the ninth (P=0.011; hazard ratio, 3.49; 95% confidence interval [CI], 1.79-6.80); the type of arrhythmia (P=0.031; electrophysiological study and atrioventricular nodal reentry tachycardia ablation having the highest probability of ZFL; hazard ratio, 6.87; 95% CI, 2.08-22.7 and hazard ratio, 2.02; 95% CI, 1.04-3.91, respectively); the operator's (P=0.002) and patient's age (P=0.009). Among operators, achievement of ZFL varied from 0% to 100%; 8 (22.8%) operators achieved ZFL in <25% of their procedures; 17 (48.6%) operators achieved ZFL in >75% of their procedures. The probability of ZFL increased by 2.8% (hazard ratio, 0.98; 95% CI, 0.97-0.99) as patient's age decreased by 1 year. Acute procedural success was obtained in all cases.CONCLUSIONS: The use of 3-dimensional mapping system completely avoided the use of fluoroscopy in most cases, with very low fluoroscopy time in the remaining and high safety and effectiveness profiles. Achievement of ZFL was predicted by the type of arrhythmia, operator's experience, and patient's age.

U2 - 10.1161/CIRCEP.117.005592

DO - 10.1161/CIRCEP.117.005592

M3 - Article

C2 - 29874166

SN - 1941-3149

VL - 11

SP - e005592

JO - Circulation: Arrhythmia and Electrophysiology

JF - Circulation: Arrhythmia and Electrophysiology

IS - 3

ER -

Predictors of Zero X-Ray Ablation for Supraventricular Tachycardias in a Nationwide Multicenter Experience

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