Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

Topalović, Mirko; Jan, Matevž; Kalinšek, Tine Prolič; Žižek, David; Štublar, Jernej; Rus, Rina; Kuhelj, Dimitrij

doi:10.3390/children10091513

Cited by 3 publications

(1 citation statement)

References 65 publications

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“… 17 , 18 This importance is only further pronounced in paediatric patients due to their extended years of potential risk and exposure, especially in CHD patients who frequently require multiple procedures involving ionizing radiation. 19 , 20 Lastly, we should not underestimate the long-term musculoskeletal and health benefits to the operator and staff as a result of reduced lead apron usage. 21 …”

Section: Discussionmentioning

confidence: 99%

Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications

Headrick,

Ou,

Asaki

et al. 2024

Europace

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Background and aims Common to adult electrophysiology studies (EPS), intracardiac echocardiography (ICE) use in pediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in pediatric and CHD EPS. Methods This single-center retrospective matched cohort study reviewed EPS between 2013 and 2022. Demographics, CHD type, and EPS data were collected. ICE cases were matched 1:1 to no ICE controls to assess differences in complications, ablation success, fluoroscopy exposure, procedure duration, and arrhythmia recurrence. Cases and controls with preceding EPS within 5 years were excluded. ICE cases without an appropriate match were excluded from comparative analyses but included in the descriptive cohort. We performed univariable and multivariable logistic regression to assess associations between variables and outcomes. Results A total of 335 EPS were reviewed, with ICE used in 196. The median age of ICE cases was 15 [IQR 12-17; range 3-47] years, and median weight 57 [IQR 45-71; range 15-134] kg. There were no ICE-related acute or post-procedural complications. There were 139 ICE cases matched to no ICE controls. Baseline demographics and anthropometrics were similar between cases and controls. Fluoroscopy exposure (P = 0.02), procedure duration (P = 0.01), and arrhythmia recurrence (P = 0.01) were significantly lower in ICE cases. Conclusion ICE in pediatric and CHD ablations is safe and reduces procedure duration, fluoroscopy exposure, and arrhythmia recurrence. However, not every arrhythmia substrate requires ICE use. Thoughtful selection will ensure the judicious and strategic application of ICE to enhance outcomes.

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Section: Discussionmentioning

confidence: 99%

Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications

Headrick,

Ou,

Asaki

et al. 2024

Europace

View full text Add to dashboard Cite

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Catheter ablation for atrial tachycardia in pediatric patients: a single-center experience

Chen,

Xu,

et al. 2024

Front. Cardiovasc. Med.

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PurposeAtrial tachycardia is an uncommon supraventricular tachycardia in children. It is often drug-resistant and likely to occur concomitantly with tachycardia-induced cardiomyopathy, making radiofrequency catheter ablation the preferred treatment. The aim of this study was to assess the feasibility, safety, and effectiveness of radiofrequency catheter ablation for the treatment of different types of atrial tachycardia in children, particularly in those with drug-resistant and tachycardia-induced cardiomyopathy.MethodsA total of 28 children with atrial tachycardia (including focal atrial tachycardia and atrial flutter) who underwent atrial radiofrequency ablation at the Children's Hospital Affiliated to Chongqing Medical University from May 2018 to December 2023 were included. The baseline characteristics, preoperative medication, surgical information, and postoperative follow-up data of these children were analyzed statistically.ResultsThe mean age patients at ablation was 10.24 ± 3.40 years. A total of 78.6% of the patients (22/28) who received preoperative pharmacological treatment had intermittent or persistent atrial tachycardia. Of the 28 children who underwent radiofrequency ablation, 24 (85.7%) were diagnosed with focal atrial tachycardia, three (10.7%) with atrial flutter, and one (3.6%) with both. No postoperative complications occurred in any patient. The immediate ablation success rate in the 25 patients with focal atrial tachycardia was 96.0% (24/25). After 26.89 ± 18.17 months of follow-up, only three patients had recurrence. The ablation difficulty of focal atrial tachycardia originating in the appendage was higher than that originating in the non-atrial appendage (44.4% vs. 6.3%, p = 0.01). The success rate of ablation for atrial flutter was 100%, except in one child with underlying cardiomyopathy who experienced recurrence. Final success was achieved in 25 of the 28 patients (89.2%) at the end of the follow-up period. In addition, eight children (28.6%) in this study were diagnosed with tachycardia-induced cardiomyopathy, with significantly increased ejection fraction and shortening rate after radiofrequency ablation (p < 0.01), whereas the left ventricular end-systolic diameter were not significantly reduced during the follow-up period (p > 0.05).ConclusionRadiofrequency catheter ablation is safe and effective for the treatment of atrial tachycardia in children in the short- and long-term.It can be used as the first treatment option for children with medically refractory atrial tachycardia and tachycardia-induced cardiomyopathy.

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Transcatheter ablation of atrioventricular nodal reentry tachycardia in children and congenital heart disease in the era of 3D mapping

Drago,

Flore,

Raimondo

et al. 2024

Front. Cardiovasc. Med.

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Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia in children and congenital heart disease (CHD) patients. Nowadays, in large enough children, chronic treatment for symptomatic and recurrent AVNRT episodes relies on transcatheter ablation. Indeed, many three-dimensional (3D) mapping strategies and ablation techniques have been developed and it helped to increase success rates and to reduce complications. Therefore, this study aimed to perform an updated comprehensive review of the available literature regarding contemporary management of AVNRT in children. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. We found that in recent times many investigations have demonstrated that 3D mapping systems allow to localize more precisely the ablation substrate, with minimal use of fluoroscopy. The most frequently employed mapping strategies are the low-voltage bridge strategy together with the search for the SP potential and the Sinus Rhythm Propagation Map with the identification of areas of Wave Collision or Pivot Points. For transcatheter ablation in pediatric settings, radiofrequency (RF) ablation was first used in the 1990s, while cryoablation was introduced in 2003 and nowadays represents the most used energy for AVNRT ablation in this population. Indeed, its specific features, such as reversible cryomapping, cryoadhesion and the precision in lesion delivery, made this technique very appealing to decrease complications and fluoroscopy time. As regards AVNRT in CHD patients, it represents the third most common form of arrhythmia in children with CHD. However, in this subgroup ablation remains challenging and experience limited, since anatomy may be atypical and the areas of ablation less predictable or less accessible.

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Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

Cited by 3 publications

References 65 publications

Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications

Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications

Catheter ablation for atrial tachycardia in pediatric patients: a single-center experience

Transcatheter ablation of atrioventricular nodal reentry tachycardia in children and congenital heart disease in the era of 3D mapping

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