No abstract

Electrophysiology study (EPS) and catheter ablation (CA) in children and adolescents carries a potentially harmful effect of radiation exposure when performed with the use of fluoroscopy. Our aim was to evaluate the feasibility, safety and effectiveness of fluoroless EPS and CA of various supra-ventricular tachycardias (SVTs) with the use of the 3D mapping system and intracardiac echocardiography (ICE). Forty-three consecutive children and adolescents (age 13 ± 3 years) underwent fluoroless EPS and CA for various supra-ventricular tachycardias. A three-dimensional (3D) mapping system NavX™ was used for guidance of diagnostic and ablation catheters in the heart. ICE was used as a fundamental imaging tool for transseptal punctures. Acute procedural success rate was 100 %. There were no procedure related complications and short-term follow up (10 ± 3 months) revealed 93 % arrhythmia free survival rate. Fluoroless CA of various SVTs in the paediatric population is feasible, safe and can be performed successfully with 3D mapping system and ICE.

Background In this retrospective study, we aimed to detect factors related to the acute success rate (ASR) of radiofrequency (RFA) and cryo-ablation (CRA) of SVTs guided by three-dimensional (3D) electroanatomical mapping (EAM) system completely without the use of fluoroscopy (FLR). Methods and results We analyzed 324 consecutive patients with SVTs [age was 30.65±20.71 (3.6–83.1) years, 147 patients <19 years old and 50.3% (163/224) patients were female]. There were 112 patients with accessory pathways (APs), 36 patients with atrial tachycardia (ATs), and 176 patients with atrioventricular nodal reentrant tachycardia (AVNRT). All procedures [(RFA (n=257), CRA (n=51), combined RFA and CRA (n=16)] were performed guided by the 3D EAM system completely without the use of FLR. Intracardiac echocardiography (ICE) was used as an imaging tool when transseptal approach was needed for treatment of left-sided arrhythmias. The acute success rate (ASR) was 90.4% (293/224). There were no procedural complications. After the first procedure, patients were divided into the “ablation success” group (group I, n=293) and the “ablation failure” group (group II, n=31). Two groups were similar in terms of age, BMI, gender distribution, and type of ablation procedure. In group II, number of ablation lesions was significantly higher than group I [respectively; 17.93±11.7 vs. 10.5±14.5; p=0.003]. Additionally, total ablation time (TAT) [respectively; 552.6±298.6 vs. 449.7±448.1; p=0.1] and total procedural time (TPT) [respectively; 116.3±54.2 vs. 94.5±82.0; p=0.05] were mildly higher. When compared to Group I, the number of patients with right-sided tachycardias was significantly higher in Group II.[67.74% (21/31 vs. 21.5% (63/293; p<0.001]. ASR was the highest for patients with AVNRT and lowest for patients with ATs [respectively; 95.4% (168/176) vs. 75.0% (27/36); p<0.001]. Binary logistic regression analysis (Nagelkerke R Square=0.201) showed that SVTs originating from the right side were an independent risk factor for procedural failure. Patients with right-sided SVTs faced an approximately 11-fold increased risk of failed ablation (OR=10.69, 95% CI 2.49–45.78, p=0.001). Type of arrhythmia, type of ablation procedure, the sex category, age, and BMI were not independent risk factors for failed ablation. A significant risk factor for recurrence could not be detected. Conclusions This study revealed that catheter ablation of SVTs completely without the use of fluoroscopy can be performed with high ASR and without procedural complications. Likewise, ASR of fluoroless ablation was the highest for patients with AVNRT and lowest for patients with AT. Moreover, right-sided SVTs were an independent risk factor for ablation failure. Funding Acknowledgement Type of funding source: None