Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure

Koca, Serhat; Akdeni̇z, Celal; Karacan, Mehmet; Tuzcu, Volkan

doi:10.1017/s1047951119000830

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…A recurrence rate of 20% and 3% was recorded during short-and long-term follow-ups. Repeat ablations achieved permanent success in all cases 24,25 . Only the last four cases were performed in our series with 3-D mapping after introducing this technology in our center.…”

Section: Interventional Treatmentmentioning

confidence: 83%

“…In a small series of four patients with a mean age of 14.5 years (4-20 years), success was achieved in all cases using noncontact mapping (EnSite ArrayTM) 23 . Two recent studies with EnSite NavXTM totaling 53 children reported an acute success rate of 95% and 100%, with a median fluoroscopy time between 1.25 and 5.1 minutes 24,25 , although fluoroscopy was not used in 91% of cases 23 .…”

Section: Interventional Treatmentmentioning

confidence: 99%

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Idiopathic left fascicular ventricular tachycardia in children and adolescents

Velázquez‐Rodríguez¹,

García-Hernández²,

Silva-Oropeza³

et al. 2022

BMHIM

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Background: Idiopathic ventricular tachycardia (VT) in children with structurally normal hearts is generally unrelated to the risk of sudden arrhythmic death. Still, it may be associated with deterioration in the quality of life. VT involving the fascicular conduction system is the most typical form of idiopathic left VT. In this retrospective study, we describe the experience of the clinical presentation, catheter ablation, and long-term follow-up of left fascicular VT in children. Methods: An electrophysiological study was performed on consecutive children at a single tertiary center. Clinical fascicular left VT was induced by programmed stimulation, and catheter ablation was guided searching for Purkinje potentials. Results: We included 18 patients (0.8 patients/year): 14 (77.8%) males and four females. The mean age of the first VT episode was 8.5 ± 5 years. Intravenous verapamil administration was effective for paroxysmal fascicular VT but not for prevention of recurrences. The mean age at the time of catheter ablation was 11. 1 ± 3.8 years (8 months-16 years). The mean weight was 36.8 ± 16.4 kg (8.7-58 kg). A 100% success rate was observed with catheter ablation after repeated procedures without major complications. Mean follow-up was 2.0 ± 1.2 years (1.0-4.0 years, median 1.5), with permanent success in all patients and no antiarrhythmic drug administration. Conclusions: Fascicular VT has an adverse clinical course in children. In most cases, this condition is drug refractory. Catheter ablation is successful and safe treatment and should represent the first-line approach in symptomatic children.

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Section: Interventional Treatmentmentioning

confidence: 83%

Section: Interventional Treatmentmentioning

confidence: 99%

Idiopathic left fascicular ventricular tachycardia in children and adolescents

Velázquez‐Rodríguez¹,

García-Hernández²,

Silva-Oropeza³

et al. 2022

BMHIM

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“…Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg (22-86), and the mean age was 13.6 ± 2.5 years (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The indication for ablation was decreased left ventricular systolic function, revealed by echocardiography (EF: 45%) in one patient due to incessant fascicular tachycardia.…”

Section: Resultsmentioning

confidence: 99%

“…However, there is limited experience in the use of mapping systems in paediatric patients with fascicular tachycardia, and conventionally, X-rays have been used for catheter navigation during these procedures. 8,9 It is known that children are very susceptible to ionising radiation beginning from fetal life. [10][11][12][13] Therefore, radiation exposure should be minimised in paediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, fluoroscopy was used only for the introduction of radiofrequency ablation and diagnostic catheters, retrogradely into the left ventricle. 9 Likewise, in our study, we used limited fluoroscopy in some patients when we had difficulty advancing our catheters through the aortic arch and the aortic valve. We believe that, with increasing knowledge and experience with electroanatomic mapping systems, physicians will Acute procedural success, % 100…”

Section: Discussionmentioning

confidence: 99%

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Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience

2020

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Objective:Fascicular tachycardia is a common form of sustained idiopathic left ventricular tachycardia. This study aimed to achieve successful results with catheter ablation procedures performed through three-dimensional electroanatomic mapping using near-zero fluoroscopy in fascicular tachycardia patients.Methods and results:In this study, we included 33 consecutive children with fascicular tachycardia, for whom we performed a transcatheter radiofrequency ablation procedure using the EnSite® system. Activation mapping was performed in all patients during tachycardia, and the earliest presystolic purkinje potentials were the target site for radiofrequency lesions.Results:Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg, and the mean age was 13.6 ± 2.5 years. The mean procedure time was 121.3 ± 44.3 minutes. The mean follow-up period was 18.4 ± 6.5 months. No fluoroscopy was needed in 30 patients. The mean fluoroscopy time in the remaining patients was 166.6 ± 80 seconds. All of the patients had left posterior fascicular tachycardia except for one who had left anterior fascicular tachycardia. The acute success rate was perfect (100%). No patients developed left bundle branch block or complete atrioventricular block. Recurrence developed in one patient.Conclusion:We suggest that radiofrequency ablations via an electroanatomic mapping system are quite safe and effective, with high success rates in paediatric patients with fascicular tachycardia. This method has the advantage of avoiding ionising radiation exposure for both the patient and operator, thus reducing the lifetime risk of malignancy in the paediatric population.

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The First Evaluation of Remote Magnetic Navigation-Guided Pediatric Ventricular Arrhythmia Ablation

et al. 2022

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Catheter ablation (CA) is an important treatment option for ventricular arrhythmias (VA) in pediatric cardiology. Currently, various CA techniques are available, including remote magnetic navigation (RMN)-guided radiofrequency (RF) ablation. However, no studies evaluate RMN-guided ablative therapy outcomes in children with VA yet. This study aimed to compare procedural and long-term outcomes between RMN-guided and manual (MAN)-guided VA ablation in children. This single-center, retrospective study included all CA procedures for VA performed in children with or without structural heart disease from 2008 until 2020. Two study groups were defined by CA technique: RMN or MAN. Primary outcome was recurrence of VA. Baseline clinical, procedural and safety data were also evaluated. This study included 22 patients, who underwent 30 procedures, with a median age of 15 (IQR 14–17; range 1–17) years and a mean weight of 57 ± 20 kg. In total, 14 procedures were performed using RMN and 16 using MAN (22 first and 8 redo procedures). Regarding first procedures, recurrence rates were significantly lower in RMN compared to MAN (20% versus 67%, P = 0.029), at a mean follow-up of 5.2 ± 3.0 years. Moreover, fluoroscopy dosages were significantly lower in RMN compared to MAN [20 (IQR 14–54) versus 48 (IQR 38–62) mGy, P = 0.043]. In total, 20 patients (91%) were free of VA following their final ablation procedure. This is the first study to investigate the use of RMN in pediatric VA ablation. RMN showed improved outcomes compared to MAN, resulting in lower VA recurrence and reduced fluoroscopy exposure.

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Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure

Cited by 4 publications

References 25 publications

Idiopathic left fascicular ventricular tachycardia in children and adolescents

Idiopathic left fascicular ventricular tachycardia in children and adolescents

Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience

The First Evaluation of Remote Magnetic Navigation-Guided Pediatric Ventricular Arrhythmia Ablation

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