Long-term follow-up after the use of the as low as reasonably achievable radiation protocol in patients with symptomatic supraventricular tachycardia

INTRODUCTION: Catheter ablation is an effective treatment modality for patients with symptomatic supraventricular tachycardia (SVT), such as atrioventricular nodal re-entrant tachycardia (AVNRT) and typical atrial flutter (TAF). With increasingly invasive electrophysiological procedures and continuous development of ablation techniques, the aim is to reduce radiation doses for patients and the electrophysiological team. Modern methods that combine the "as low as reasonably achievable" (ALARA) protocol and three-dimensional mapping systems are now state-of-the-art procedures in the treatment of arrhythmia. This study aimed to compare the effectiveness and long-term success of the ALARA approach compared to those of conventional therapy, without using modern mapping systems.

METHODS: Sixty-one patients with symptomatic SVT (37 with AVNRT, 19 with isthmus-dependent counter-clockwise TAF, and five with other SVTs) were randomised into two groups: the ALARA and conventional groups. All patients underwent successful SVT ablation. Clinical and remote follow-up was available for 59 patients after a mean period of 3.2 years.

RESULTS: The mean fluoroscopy time was significantly shorter in the ALARA group (1.1 min vs. 8.4 min, p < 0.01). Regarding complications and recurrences, during a median follow-up period of 3.2 years, eight patients (13.5%) had recurrences, all of which occurred in the conventional group.

CONCLUSION: This study confirmed a significantly lower radiation burden for patients and the entire electrophysiological team with the ALARA approach and a significantly increased risk of recurrence and complications with the conventional approach. The reduction in radiation time and high long-term success indicate the utility of the ALARA protocol in daily practice.