Background and aims: Zero-fluoroscopy (ZF) catheter ablation eliminates radiation exposure via use of 3-dimensional electroanatomical mapping. We aimed to assess safety and efficacy of ZF catheter ablation in the treatment of supraventricular tachycardias (SVTs), examine learning-curve characteristics and to evaluate long-term results and mortality.Methods: We analysed clinical characteristics, procedural and follow-up data of 605 consecutive patients undergoing catheter ablation for SVT (atrioventricular nodal re-entry tachycardia, n = 297; atrial flutter, n = 241 and accessory pathway mediated tachycardia, n = 67) between June 2017 and September 2021. Procedures were either guided by conventional fluoroscopy (F, n = 223) or by EnSite Precision mapping system (ZF, n = 382) based on decision of the operating physician.Results: Acute procedural success rate exceeded 98% across all arrhythmia groups for both ZF and F techniques (ZF: 99%, F: 100%, p = NS). 63% of patients underwent ZF procedures. Complication rate was low (0.66%), occurring only in the F group. Conversion rate to fluoroscopy was 7.8%. ZF procedures took an average of 5.1 min longer (ZF: 64.5 ± 24.3 min vs. F: 59.4 ± 29 min, p < 0.05), however ZF procedure times were reduced over time. At 3.2 years, total mortality was 7% with no significant difference between ZF and F. Deaths were not related to the procedures. Atrial flutter showed significantly higher recurrence in ZF compared to F (83% vs. 94%, p < 0.005).Conclusion: Catheter ablation of SVTs using zero-fluoroscopy approach have similar acute success, complication and mortality rate as conventional fluoroscopic interventions. However, we detected significantly higher long-term arrhythmia recurrence after ZF ablation of atrial flutter, meriting further investigation.

Background: Left atrial appendage closure (LAAC) is an established alternative to oral anticoagulation for stroke prevention in patients with nonvalvular atrial fibrillation who are at high risk of thromboembolic events or bleeding complications. Methods: In this single-center retrospective study, we analyzed 70 consecutive patients who underwent successful LAAC with the Watchman™ device between 2012 and 2024. Acute procedural outcomes, long-term thromboembolic and bleeding events, transfusion requirements and mortality were evaluated. Mean follow-up duration was 1210 days. Results: Procedural success was achieved in 98.6% of cases with a low periprocedural complication rate. Ischemic stroke/transient ischemic attack occurred in 2.8% of patients; no hemorrhagic strokes or stroke-related deaths were observed. LAAC resulted in a significant reduction in both the number (144 vs. 56 events; 2.36 vs. 1.55 events per patient, p < 0.05) and severity of bleeding events. Nonetheless, 42.9% of patients required bleeding-related hospitalization after implantation, predominantly within the first 6 months during dual antiplatelet therapy. Overall mortality was 40% with a 12% yearly mortality rate; heart failure and infections were leading causes of death. Pre- and postprocedural transfusion requirements were independently associated with a six-fold increase in mortality risk (HR = 5.97). Conventional risk scores (CHA₂DS₂-VASc, HAS-BLED) failed to predict transfusion needs; atrial enlargement, right ventricular dysfunction, smoking and alcohol consumption were associated with higher risk. Conclusions: LAAC is a safe and effective alternative to long-term anticoagulation, significantly reducing bleeding burden without increasing thromboembolic mortality. Persistent postprocedural bleeding remains a major determinant of long-term prognosis, underscoring the need for individualized, multidisciplinary post-implant management.

Introduction: Typical atrial flutter (AFL) is associated with considerable morbidity and mortality despite high procedural success rates of cavotricuspid isthmus (CTI) ablation. While the CHA₂DS₂-VA score is widely used for thromboembolic risk assessment in atrial fibrillation, its prognostic value for long-term survival after CTI ablation remains unclear. Our objective therefore was to evaluate the association between the CHA₂DS₂-VA score, its individual components, and non-CHA₂DS₂-VA comorbidities with all-cause mortality following CTI ablation for typical AFL. Methods: We retrospectively analyzed clinical and mortality data from 249 consecutive patients who underwent successful CTI ablation between July 2017 and December 2021. Kaplan-Meier survival analysis, Cox regression, and time-dependent ROC analyses were performed to evaluate predictors of all-cause mortality. Results: During a mean follow-up of 1771 ± 635 days, 27% of patients died. Mortality increased progressively with higher CHA₂DS₂-VA scores, corresponding to a stepwise decline in survival (log-rank p < 0.001). A CHA₂DS₂-VA score ≥3 was identified as the optimal threshold for mortality prediction, with annual mortality rates of 1.4% versus 9.9% in patients with scores <3 and ≥3, respectively ( p < 0.001). The CHA₂DS₂-VA score demonstrated good discriminative ability (c-index = 0.73). In multivariable analysis, the CHA₂DS₂-VA score remained an independent predictor of all-cause mortality (HR 1.48, 95% CI 1.26 -1.75, p < 0.001). Among non-CHA₂DS₂-VA variables, pulmonary disease and obstructive sleep apnoea independently predicted adverse long-term survival, whereas female sex was not significantly associated with mortality. Discussion: The CHA₂DS₂-VA score is an independent predictor of long-term all-cause mortality after CTI ablation for typical AFL, extending its clinical utility beyond thromboembolic risk assessment. Incorporation of selected non-CHA₂DS₂-VA comorbidities may further refine risk stratification and support individualized follow-up strategies.