Comparison between remotely supported nurse-led electro-anatomic mapping and standard onsite engineer support for electrophysiological procedures.

Aims: Catheter ablations of complex cardiac arrhythmias are currently guided by electro-anatomic mapping (EAM) systems. The aim of this study was to compare two different approaches: remotely supported nurse-led EAM with standard onsite engineer support.

Methods and results: In this retrospective observational study, 166 patients with complex and non-complex procedures were included. A total of 82 patients benefited from EAM with remotely supported nurse-led mapping (mean age: 62 ± 16 years), while the approach for 84 patients was with standard onsite engineer support (mean age: 56 ± 19 years). Procedural characteristics, acute results, and complication rates were compared between both groups and showed similar results. Complex and non-complex procedures were conducted in both groups, including left atrial and ventricular procedures. As ventricular tachycardia and accessory pathway ablations were more frequently conducted with standard onsite engineer support, we separately analysed the largest subgroup, 105 patients with atrial fibrillation, left atrial flutter, and left atrial tachycardia. Patients in this subgroup had comparable baseline characteristics, procedure times, and procedural success. Nevertheless, there were longer ablation times and more utilization of fluoroscopy in the onsite group, most likely due to more complex procedures.

Conclusion: Our results underline the practicality of remotely supported nurse-led EAM. The latter approach proved to be a safe alternative to onsite engineer support. Due to its advantages, particularly for insular settings, it will likely play a greater role in the future.