Ab-452673-4 fluoroscopic reliance during ventricular arrhythmia ablation has decreased over time

Historically, fluoroscopic utilization was high during EP procedures. Over the years, advancements in technology, including 3D mapping and intracardiac ultrasound have enabled electrophysiologists to perform complex ablation procedures safely with a very little or no fluoroscopic utilization. To evaluate the trends of fluoroscopic exposure and complication rates over time during ventricular arrhythmia (VA) ablation. We reviewed our institutional data on fluoroscopic utilization for VA ablation between 2009 to 2022. Patients who underwent epicardial, needle, and alcohol ablation were excluded due to the nature of these procedures. We also reviewed if adjunct pre-procedure imaging with contrast enhanced CT scan (inHEART Models (Pessac, France)) affected total fluoroscopy time during complex VA ablations. SPSS software was used for statistical analysis. Among 2297 total VA ablations, detailed fluoroscopy data was available for 2266 (98.7%) procedures. Of those, 1311 (57.8%) had ventricular tachycardia (VT) ablation, 838 (37%) had premature ventricular contraction (PVC) ablation, and the rest had either epicardial, needle, or alcohol ablation. Since 2017, the portion of completely fluoroscopy free VA ablation increased (Figure 1B) from 1% in 2017 to 42.3% in 2022 (P < 0.001). Mean fluoroscopy duration and dose decreased dramatically over time, and this reduction remained statistically significant despite analyzing only procedures that utilized fluoroscopy (Figure 1A). For VT ablation, mean fluoroscopy dose per ablation was 836.6 mGy in 2009 as compared to 41.4 mGy in 2022, and for PVC ablation, mean fluoroscopy dose per ablation was 562.8 mGy in 2009 as compared to 44.4 mGy in 2022. Intra procedure complication rates were similar among the groups - 0.9% in procedures with fluoroscopic utilization, and 0.9% in procedures with zero fluoroscopy (P=0.664). Additionally, total fluoroscopy time was much lower in patients with pre-procedure contrast enhanced CT scans (10.9 +/- 7.4 minutes) compared to patients who did not have a scan (22+/- 15.9 minutes) (P<0.001). Perception of high fluoroscopic exposure during EP procedures is common in the medical community, and this study highlights that with current advancements in technology, the ability to perform low fluoroscopy or complete fluoroscopy free VA ablation improved dramatically over years without compromising safety. Pre-procedure planning and imaging guidance can help further decrease fluoroscopic utilization.