Three-Dimensional Electroanatomic Mapping-Guided Complete Zero-Fluoroscopy Ablation of Premature Ventricular Complexes: Feasibility and Patient Selection Characteristics

Tóm tắt

Background: Complete zero-fluoroscopy ablation of premature ventricular complexes (PVCs) guided by three-dimensional electroanatomic mapping may eliminate radiation exposure. However, its feasibility depends on appropriate patient selection, particularly in settings where intracardiac echocardiography is not routinely available.

Objective: To evaluate the feasibility of complete zero-fluoroscopy PVC ablation and to identify electrocardiographic characteristics associated with successful completion of the procedure without fluoroscopy.

Methods: This descriptive observational study included patients undergoing catheter ablation for PVCs at the Cardiovascular Center, E Hospital, from January 2025 to May 2026. Clinical characteristics, 12-lead electrocardiographic findings, Holter data, anatomical sites of origin, and procedural outcomes were analyzed according to whether the procedure was completed entirely without fluoroscopy.

Results: A total of 60 patients were included. Forty patients were initially selected for a complete zero-fluoroscopy strategy, of whom 37 completed the procedure without fluoroscopic guidance, yielding a feasibility rate of 92.5%. Three patients crossed over to fluoroscopic support; the final sites of origin were the right coronary cusp in one patient and suspected intramural origins in two patients. Compared with the fluoroscopy-used group, the complete zero-fluoroscopy group had a lower R/RS ratio in lead V2 during PVCs (0.13 ± 0.10 vs. 0.42 ± 0.34, p < 0.001), a later PVC precordial transition index (2.94 ± 1.10 vs. 2.00 ± 0.60, p < 0.001), and a lower V2 transition ratio (0.41 ± 0.31 vs. 1.94 ± 2.90, p < 0.001). In the complete zero-fluoroscopy group, acute procedural success was achieved in 97.3% of patients; mean procedural time was 60.1 ± 29.2 minutes and mean ablation time was 346.5 ± 196.4 seconds. No major complications occurred.

Conclusion: Three-dimensional electroanatomic mapping-guided complete zero-fluoroscopy ablation of PVCs is highly feasible in appropriately selected patients. Electrocardiographic features suggesting late precordial transition may support patient selection for this strategy.