The Efficacy And Safety Of The Zero-fluoroscopy Catheter Ablation For Premature Ventricular Contractions Originating From The Right Ventricular Outflow Tract

BackgroundA premature ventricular contractions(PVC)isan ectopic beat mediated by electrical activityoriginating anywhere in the heart,excluding ofcourse the atrium.The most common origin inpatients without structural heart disease is theright ventricular outflow tract(RVOT),whereasthe majority of patients with structural heart diseasehavePVCSoriginatingfromtheleftventricle.PVCs are a frequent and normal finding inhealthy individuals,occurring in 6% of patients aged 45–65 years old.Their prevalence increaseswith age.In patients referred for Holter monitoringfor various reasons,1.3% of patients have veryfrequent PVC(more than 20% of heartbeats).PVC clinical manifestation of great variability,the most common is heart palpitations,flustered,serious person can trigger malignant arrhythmia caused by amaurosis,syncope,sudden death.Recent studies have found that the risk of left ventricular dysfunction and dilated cardiomyopathy may be due to frequent ventricular premature,Radiofrequency catheter ablation can successfully reverse premature ventricular cardiomyopathy.However,the traditional radio frequency ablation in the presence of radiation damage,(Radio Frequency Catheter Ablation RFCA)guided by three dimensional mapping system can reduce the exposure of intraoperative x-ray,and the operation is more safe and accurate and efficient,and some can even reach zero ray to complete the operation.ObjectivesTo evaluate theefficacy andsafetyof radiofrequency catheter ablation of idiopathic premature ventricular contractions originating from the right ventricular outflow tract(RVOT-PVCs)with zero-fluoroscopic strategy under the guidance of Carto3 three-dimensional electroanatomic mapping system comparing to the conventional guidance of X-ray exposure.MethodsTotal of46 consecutive patients with RVOT-PVCs prospectively enrolled from June 2014 to December 2015 were divided into group A(n=21,Carto3 mapping systemguided)or group B(n=25,conventional fluoroscopy guided).The mapping time,the number of discharges,the immediate success rate,the operation time,the X-ray exposure time,and the long-term success rate and complication rate were compared between groups,the results were statistically analyzed.ResultsNo significant differences were found in the acute success rates between the 2 groups [20/21(95.2%)vs 23/25(92.0%),P=0.658];No major complications occurred during the procedures in group A,1 cardiac tamponade occured ingroup B and recovered after the pericardial drainage.Theprocedure time(61.1±9.7vs 80.7±34.2 min,P=0.01),energy deliveries(4.6±1.0 vs 8.7±2.5,P<0.01)and mapping time(3.5±0.8 vs 6.6±2.7min,P<0.01)were significantly decreased in group A..The long-time success rate were similar between groups after a 15±9-month follow-up.ConclusionCompared with the conventional fluoroscopic approach,catheter ablations of RVOT-PVCs guided by the three-dimensional electroanatomic mapping system Carto3 without fluoroscopy exposure is effective and safe.The advantages also exist in the decreased mapping times,energy diliveries and procedure times.