Zero-fluoroscopy approach for radiofrequency catheter ablation of left-sided, idiopathic ventricular arrhythmias - feasibility, efficacy, and safety evaluation.

Introduction: Catheter ablation (CA) is the standard treatment for patients with symptomatic, idiopathic ventricular arrhythmias (VAs): premature ventricular contractions (PVCs) or sustained/non-sustained ventricular tachycardia. Three-dimensional electroanatomic mapping (3D EAM) systems enable accurate mapping of cardiac arrhythmias and precise catheter guidance, eliminating the need for radiation exposure. However, fluoroscopy may be required to pass through the arteries, valve, or catheter positioning near critical structures. Aim: The study assessed the feasibility, efficacy, and safety of performing CA using a zero-fluoroscopy approach in patients with left-sided idiopathic VAs with the 3D EAM system. Material and methods: Fifty-three consecutive patients with left-sided, idiopathic VAs undergoing elective CA were enrolled. Procedures were performed using the CARTO 3D EAM system with the intention of eliminating fluoroscopy usage whenever possible. The primary endpoints were the feasibility of performing the procedure without fluoroscopy and the acute and long-term (minimum 6-month follow-up) procedural efficacy. Demographic and clinical baseline characteristics, procedure parameters, and complications were included in the analysis. Results: CA of left-sided VAs was performed without fluoroscopy in 44 out of 53 (83%) cases. Acute procedural success was achieved in 47 cases (88.7%). Long-term success was achieved in 45 cases (84.9%). Minor complications occurred in 3.7% of patients. No major complications were observed. Conclusions: CA guided by 3D EAM without fluoroscopy is feasible and safe for left-sided VA.