Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-23T08:51:57.715Z Has data issue: false hasContentIssue false
  • English
  • Français

Acute outcomes of three-dimensional mapping for fluoroscopy reduction in paediatric catheter ablation for supraventricular tachycardia

Part of: Interventional Cardiology Electrophysiology

Published online by Cambridge University Press:  26 March 2021

Chris Anderson ,
Maryam Rahman Open the ORCID record for Maryam Rahman [Opens in a new window] ,
David J. Bradley ,
Kristen Breedlove ,
Macdonald Dick ,
Martin J. LaPage ,
Alaina R. Martinez ,
Neil L. McNinch ,
Jeremy P. Moore  and
John Papagiannis
...Show all authors
Chris Anderson
Affiliation:
Center for Congenital Heart Disease, Providence Sacred Heart Children’s Hospital, Spokane, WA, USA
Maryam Rahman*
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
David J. Bradley
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Kristen Breedlove
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
Macdonald Dick
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Martin J. LaPage
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Alaina R. Martinez
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
Neil L. McNinch
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
Jeremy P. Moore
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
John Papagiannis
Affiliation:
Division of Cardiology, Children’s Mercy Hospital, Kansas City, MO, USA
Mansour Razminia
Affiliation:
Clinical Cardiac Electrophysiology, Amita Health Saint Joseph Hospital, Elgin, IL, USA
Kevin M. Shannon
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
Lisa M. Shauver
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
Volkan Tuzcu
Affiliation:
Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
John M. Clark
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
*
Author for correspondence: Dr M. Rahman, The Heart Center, Akron Children’s Hospital, One Perkins Square, Akron, OH44308, USA. Tel: +543 8521. Fax: 330-543-8208. E-mail: mrahman@akronchildrens.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.

Methods:

Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications.

Results:

In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01).

Conclusions:

In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.

Keywords

Catheter ablationthree-dimensional mappingfluoroscopyradiationsupraventricular tachycardiapaediatric
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 12 , December 2021 , pp. 1923 - 1928
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Van Hare, GF, Javitz, H, Carmelli, D, et al. Prospective assessment after pediatric cardiac ablation. J Cardiovasc Electrophysiol 2004; 15: 759–770.CrossRefGoogle ScholarPubMed
Collins, KK, Dubin, A, Chiesa, N, McDaniel, G, Van Hare, GF. Cryoablation in pediatric atrioventricular nodal reentry: electrophysiologic effects on atrioventricular nodal conduction. Heart Rhythm 2006; 3: 557–563.CrossRefGoogle ScholarPubMed
Tuzcu, V. Cryoablation of accessory pathways in children. Pacing Clin Electrophysiol 2007; 30: 1129–1135.10.1111/j.1540-8159.2007.00824.xCrossRefGoogle ScholarPubMed
Drago, F, Russo, MS, Silvetti, MS, De Santis, A, Iodice, F, Onofrio, MT. Cryoablation of typical atrioventricular nodal reentrant tachycardia in children: six years’ experience and follow-up in a single center. Pacing Clin Electrophysiol 2010; 33: 475–481.CrossRefGoogle ScholarPubMed
Dubin, AM, Jorgensen, NW, Radbill, AE, et al. What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous ablation registries. Heart Rhythm 2019; 16: 57–63.10.1016/j.hrthm.2018.08.013CrossRefGoogle Scholar
Kirchhof, P, Loh, P, Eckardt, L, et al. A novel nonfluoroscopic catheter visualization system (LocaLisa) to reduce radiation exposure during catheter ablation of supraventricular tachycardias. Am J Cardiol 2002; 90: 340–343.CrossRefGoogle ScholarPubMed
Smith, G, Clark, JM. Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing Clin Electrophysiol 2007; 30: 510–518.CrossRefGoogle Scholar
Tuzcu, V. A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system. Pacing Clin Electrophysiol 2007; 30: 519–525.CrossRefGoogle ScholarPubMed
Miyake, CY, Mah, DY, Atallah, J, et al. Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 2011; 8: 519–525.CrossRefGoogle ScholarPubMed
Papagiannis, J, Avramidis, D, Alexopoulos, C, Kirvassilis, G. Radiofrequency ablation of accessory pathways in children and congenital heart disease patients: impact of a nonfluoroscopic navigation system. Pacing Clin Electrophysiol 2011; 34: 1288–1396.CrossRefGoogle ScholarPubMed
Wan, G, Shannon, KM, Moore, JP. Factors associated with fluoroscopy exposure during pediatric catheter ablation utilizing electroanatomical mapping. J Interv Card Electrophysiol 2012; 35: 235–242.CrossRefGoogle ScholarPubMed
Kean, AC, LaPage, MJ, Yu, S, Dick, M, Bradley, DJ. Patient and procedural correlates of fluoroscopy use during catheter ablation and congenital electrophysiology lab. Congenit Heart Dis 2015; 10: 281–287.CrossRefGoogle ScholarPubMed
Razminia, M, Willoughby, MC, Demo, H, et al. Fluoroless catheter ablation of cardiac arrhythmias: a 5-year experience. Pacing Clin Electrophysiol 2017; 40: 425–433.CrossRefGoogle ScholarPubMed
Schauer, DA, Linton, OW. NCRP report no. 160, ionizing radiation exposure of the population of the United States, Medical exposure - are we doing less with more, and is there a role for health physicists? Health Phys 2009; 97: 1–5.CrossRefGoogle Scholar
Brenner, DJ, Doll, R, Goodhead, DT, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 2003; 100: 13761–13766.CrossRefGoogle ScholarPubMed
Beels, L, Bacher, K, De Wolf, D, Werbrouck, J, Thierens, H. Gamma-H2AX foci as a biomarker for patient x-ray exposure in pediatric cardiac catheterization: are we underestimating radiation risks? Circulation 2009; 120: 1903–1909.CrossRefGoogle ScholarPubMed
Skanes, AC, Dubuc, M, Klein, GJ, et al. Cryothermal ablation of the slow pathway for the elimination of atrioventricular nodal reentrant tachycardia. Circulation 2000; 102: 2856–2860.10.1161/01.CIR.102.23.2856CrossRefGoogle ScholarPubMed
De Ponti, R, Tritto, M, Lanzotti, M, et al. Successful selective ablation of fast atrioventricular node pathway by cryothermal energy application. Pacing Clin Electrophysiol 2004; 27: 1170–1171.CrossRefGoogle ScholarPubMed
Law, IH, Von Bergen, NH, Gingerich, JC, Saarel, EV, Fischbach, PS, Dick, M. Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart. Heart Rhythm 2006; 3: 903–907.CrossRefGoogle ScholarPubMed