Comparison of operator radiation exposure during coronary sinus catheter placement via the femoral or jugular vein approach.

AIMS: To evaluate and compare operator radiation exposure during the catheter placement in the coronary sinus via the femoral vein with a steerable catheter or the jugular vein with a fixed curve catheter. METHODS AND RESULTS: A total of 156 patients undergoing electrophysiological study or radiofrequency catheter ablation were prospectively assigned in a random fashion to either the femoral vein access (FVA) with a steerable curve deca-polar catheter (n= 80) or the jugular vein access (JVA) with a fixed curve deca-polar catheter (n = 76). All the catheterization procedures were performed by the same operator who had extensive experience in both accesses. Operator radiation exposure was measured with an electronic radiation dosimeter attached to the breast pocket of the operator on the outside of the lead apron and estimates of the ambient dose equivalent were derived. The operator radiation exposure was reduced significantly by using the FVA compared with the JVA (1.8 ± 1.3 vs. 8.6 ± 6.5 µSv; P < 0.001). The fluoroscopy time (62.7 ± 45.8 vs. 61.9 ± 46.5 s; P = NS) and dose-area product (3.2 ± 2.3 vs. 3.1 ± 2.1 Gy cm(2); P = NS) were not statistically different. CONCLUSION: Operator radiation exposure can be significantly reduced by using the FVA approach with a steerable curve catheter compared with the JVA approach with a fixed curve catheter, without increasing the fluoroscopy time and dose-area product.

Radiofrequency ablation of the ventricular tachycardia with arrhythmogenic right ventricular cardiomyopathy using non-contact mapping.

BACKGROUND: Intracardiac non-contact mapping provides a rapid and accurate isopotential mapping that facilitates catheter ablation of the ventricular tachyarrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS: Thirty-two consecutive patients (26 men and 6 women, mean 37.2 +/- 13.8 years) were treated with ablation. Fourteen patients had a history of syncope/pre-syncope. Two patients had an implantable cardiac defibrillator (ICD) previously implanted. RESULTS: There were 67 ventricular tachycardias (VTs) induced in the 32 patients. The average VT rate was 210 +/- 32.2 (130-310) bpm. There were 42 episodes of VT that had a heart rate > or =200 bpm and 24 of the 32 patients (75%) had > or =2 morphologies of VT. Regional ablation was applied by targeting the earliest VT activation sites under the guidance of non-contact mapping. Acute success was achieved in 84.4% (27/32) patients, and significant improvement was seen in 15.6% (5/32) patients as evidenced by a slower rate of VT. None of the patients experienced syncope/pre-syncope or sudden death during the 28.6 +/- 16 (9-72) month follow-up. There were no complications of the procedure. At the end of follow-up, 81.3% of the patients were free of VT without medication while the rest of the patients achieved a modified success. CONCLUSIONS: The rapid ventricular tachyarrhythmias in ARVC patients can be abolished or improved significantly by regional RF catheter ablation under the guidance of non-contact mapping. There was no sudden cardiac arrest or death in those patients without ICD implantation. Delayed efficacy may occur in some patients after ablation.