Zero‐Fluoroscopy Ablation of Accessory Pathways in Children and Adolescents: CARTO3 Electroanatomic Mapping Combined with RF and Cryoenergy. Issue 6 (15th April 2015)

• Record Type: Journal Article
• Authors: Scaglione, Marco; Ebrille, Elisa; Caponi, Domenico; Siboldi, Alessandra; Bertero, Giovanni; Di Donna, Paolo; Gabbarini, Fulvio; Raimondo, Cristina; Di Clemente, Francesca; Ferrato, Paolo; Marasini, Maurizio; Gaita, Fiorenzo
• Is Part Of: Pacing and clinical electrophysiology. Volume 38:Issue 6(2015:Jun.)
• Page Start: 675
• Page End: 681
• Publication Date: 2015-04-15
• Subjects: Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.12619
• Languages: English
• ISSNs: 0147-8389

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="pace12619-sec-0010" sec-type="section"> <title>Background</title> <p>Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients to the potential risk of radiation considering the sensitivity of this population and its longer life expectancy. We evaluated the feasibility, safety, and efficacy of accessory pathway (AP) ablation guided by CARTO3 electroanatomic mapping (EAM) system with both cryoenergy and radiofrequency (RF) energy in order to avoid x‐ray exposure in pediatric patients.</p> </sec> <sec id="pace12619-sec-0020" sec-type="section"> <title>Methods</title> <p>We included 44 patients (mean age: 13.1 ± 3.3 years); nine of 44 presented concealed AP. An electrophysiological study with a three‐dimensional EAM reconstruction was performed in every patient with a venous transfemoral direct right atrium approach or an arterial transfemoral retrograde approach to reach the mitral annulus. In two patients with left‐sided AP, the ablation was performed via a patent foramen ovale.</p> </sec> <sec id="pace12619-sec-0030" sec-type="section"> <title>Results</title> <p>A total of 47 APs were present, left sided in 45% (21/47) of cases (15 lateral, one anterior, three posteroseptal, and two posterolateral) and right sided in 55% (26/47; one anterior, three anterolateral, one posterolateral, three lateral, five para‐Hisian, 12 posteroseptal, and one anteroseptal). Ablation without the use of fluoroscopy was successfully performed in every patient (33 with RF and in 11 with cryoenergy). No complication occurred. At a mean follow‐up of 16.0 ± 11.7 months, we observed seven recurrences, three of them successfully re‐ablated without fluoroscopy. In one case cryoablation of a para‐Hisian AP was ineffective in the long term.</p> </sec> <sec id="pace12619-sec-0040" sec-type="section"> <title>Conclusions</title> <p>Three‐dimensional EAM allowed a safe and effective fluoroless AP ablation procedure in a pediatric population both with RF and cryoenergy.</p> </sec> </abstract>