Catheter Ablation With Mapping Likely Bests Conventional Approach to Tachycardia Over the Long Term

By Marilynn Larkin

May 07, 2021

NEW YORK (Reuters Health) - Catheter ablation of supraventricular tachycardia (SVT) using a minimal fluoroscopic approach (MFA) and electroanatomic mapping (EAM) achieved better long-term outcomes and fewer complications than conventional ablation (ConvA), a single center retrospective study suggests.

"Our article should raise awareness that MFA may help not only in reducing X-ray exposure, which is of paramount importance, but also in improving the results of the procedure, which means shorter hospital stay and fewer re-do procedures," Dr. Marco Bergonti of the University of Milan told Reuters Health by email.

As reported in JACC: Clinical Electrophysiology, Dr. Bergonti and colleagues analyzed arrhythmia recurrence and long-term complications among all patients undergoing MFA catheter ablation of SVT (atrioventricular nodal reentrant tachycardia and atrioventricular re-entrant tachycardia) at the center between 2010-2015, and compared them (1:2) with matched patients undergoing ConvA during the same period.

The analysis included 206 MFA patients and 412 treated with ConvA. Patients' mean age was 38 and 60% were women.

Acute success (99% vs. 97%) and acute complications (2.4% vs. 5.3%) were similar between the groups. Short-term complications included those involving vascular access, cardiac tamponade, and any degree of permanent or transient atrioventricular block.

Sixty-seven patients (32.5%) in the MFA group required fluoroscopy during the procedure. In this subgroup, fluoroscopy time was less than five minutes in 57 patients (85.1%). Fluoroscopy time and radiation exposure were significantly greater in patients referred for ConvA.

During a median follow-up of 4.4 years, 5.9% of patients experienced arrhythmia recurrence. In multivariate analysis, ConvA (hazard ratio, 3.03) and procedural success (HR, 0.10) were independently associated with recurrence of arrhythmias. Notably, ConvA patients' risk of arrhythmia recurrence was more than twice that of MFA patients.

Late complications - i.e., advance atrioventricular block and need for pacemaker implantation - occurred more frequently with ConvA (3.4% vs. 0.5%).

Dr. Bergonti said, "The main limit to the widespread application of MFA is cost. Indeed, in many countries, EAM systems are not reimbursed by the national health system or private insurance for first procedure SVT ablation."

Dr. Muhammad Afzal, an electrophysiologist at The Ohio State University Wexner Medical Center in Columbus, commented in an email to Reuters Health, "Technology has made SVT ablations safe and efficacious. If affordable, such procedures should be done using mapping systems."

"Over 99% of the hospitals in the United States doing such procedures routinely use mapping systems already," he noted. "U.S. trainees from the past 15-20 years don't even know how to do these ablations without mapping systems. In that regard, this study is not relevant to the U.S. health system."

SOURCE: JACC: Clinical Electrophysiology, online April 28, 2021.