Near zerO fluoroscopic exPosure during catheter ablAtion of supRavenTricular arrhYthmias: the NO-PARTY multicentre randomized trial

作者：Casella Michela^*; Dello Russo Antonio; Pelargonio Gemma; Del Greco Maurizio; Zingarini Gianluca; Piacenti Marcello; Di Cori Andrea; Casula Victor; Marini Massimiliano; Pizzamiglio Francesca; Zucchetti Martina; Riva Stefania; Russo Eleonora; Narducci Maria Lucia; Soldati Ezio; Panchetti Luca; Startari Umberto; Bencardino Gianluigi; Perna Francesco; Santangeli Pasquale; Di Biase Luigi; Cichocki Fabrizio; Fattore Giovanni; Bongiorni Mariagrazia; Picano Eugenio

来源：Europace, 2016, 18(10): 1565-1572.

DOI：10.1093/europace/euv344

• Supraventricular tachycardia
• Radiofrequency ablation
• Electroanatomical mapping
• Radiation exposure

Aim of this study was to compare a minimally fluoroscopic radiofrequency catheter ablation with conventional fluoroscopy-guided ablation for supraventricular tachycardias (SVTs) in terms of ionizing radiation exposure for patient and operator and to estimate patients' lifetime attributable risks associated with such exposure.
We performed a prospective, multicentre, randomized controlled trial in six electrophysiology (EP) laboratories in Italy. A total of 262 patients undergoing EP studies for SVT were randomized to perform a minimally fluoroscopic approach (MFA) procedure with the EnSite(TM)NavX(TM) navigation system or a conventional approach (ConvA) procedure. The MFA was associated with a significant reduction in patients' radiation dose (0 mSv, iqr 0-0.08 vs. 8.87 mSv, iqr 3.67-22.01; P < 0.00001), total fluoroscopy time (0 s, iqr 0-12 vs. 859 s, iqr 545-1346; P < 0.00001), and operator radiation dose (1.55 vs. 25.33 A mu S per procedure; P < 0.001). In the MFA group, X-ray was not used at all in 72% (96/134) of cases. The acute success and complication rates were not different between the two groups (P = ns). The reduction in patients' exposure shows a 96% reduction in the estimated risks of cancer incidence and mortality and an important reduction in estimated years of life lost and years of life affected. Based on economic considerations, the benefits of MFA for patients and professionals are likely to justify its additional costs.
This is the first multicentre randomized trial showing that a MFA in the ablation of SVTs dramatically reduces patients' exposure, risks of cancer incidence and mortality, and years of life affected and lost, keeping safety and efficacy.
clinicaltrials.gov Identifier: NCT01132274.

• 出版日期2016-10