Supplementary Material for: Feasibility, Efficiency and Safety of Zero-Fluoroscopy Catheter Interventions for Right-sided Cardiac Arrhythmias using only Electroanatomic Mapping

Introduction: Fluoroscopy is traditionally used for catheter interventions in electrophysiology but carries a long-term health risk. Besides additional invasive procedures to achieve zero-fluoroscopy interventions, electroanatomic mapping may be an alternative to fluoroscopy without the need of additional procedures. We aimed to investigate the feasibility, safety and efficiency of a zero-fluoroscopy approach using only electroanatomic mapping (ZF) compared to a conventional fluoroscopic approach (CF) for patients with right sided cardiac arrhythmias. Methods: We performed a single center retrospective cohort study of consecutive patients undergoing catheter interventions for electrophysiologic procedures from January 2019 to December 2020. Patients with left-sided arrhythmias, focal cryoablation, implanted endocardial devices or additional interventions requiring fluoroscopy were excluded. Results: 202 patients underwent a ZF and 126 patients underwent a CF approach for right-sided cardiac arrhythmias. Apart from atrial fibrillation (ZF 16% vs CF 9%, p=0.044), baseline demographics were similar in both groups. Acute success rate was 100% in the ZF group and 97.9 % in the CF group. Mean procedure time was lower in the ZF group (70 ± 36 vs 87 ± 44 min, p=0.0001), while ablation time (356 ± 324 vs 320 ± 294 seconds, p=0.157) was similar. Total complication rate was low in general (1.0 % major, 2% minor complications) and without a difference between both groups. Conclusion: A zero-fluoroscopy approach using only electroanatomic mapping without additional invasive procedures to diagnose and treat right-sided cardiac arrhythmias is feasible, efficient, and safe.