Impact of a computer assisted navigation system on radiation exposure during pediatric ablation procedures.
BACKGROUND
During catheter ablation procedures, non-radiologic navigation systems may reduce fluoroscopic exposure and energy applications, as well as improve procedural success rates.


OBJECTIVE
To examine the impact of a non-radiologic navigation system on ablation procedures in pediatric patients, the procedural characteristics and success rates prior to and following incorporation of the LocaLisa (LL) navigation system into a pediatric electrophysiology laboratory were compared.


METHODS
Between January 2000 and April 2005, 246 consecutive patients underwent catheter ablation for either Atrioventricular Reentry Tachycardia AVRT (168) or Atrioventricular Nodal Reentry Tachycardia AVNRT (78). Ablation procedures performed prior to LL (108) were compared to ablation procedures performed using LL (113). The first 25 patients using LL were censored to remove the bias of a learning curve.


RESULTS
There was no difference in demographic features between the two groups. Statistically significant decreases were found in the diagnostic (11.4 +/- 6.1 min v 18.8 +/- 9.8 min w/o LL), ablation (5.7 +/- 10.3 vs 18.5 +/- 20.1 min w/o LL) and total (17.2 +/- 12.6 vs 37.3 +/- 21.3 min w/o LL) fluoroscopy times for the LL group, as well as in the total number of energy applications (9.0 +/- 8.5 vs 12.3 +/- 12.2 w/o LL). Success rates were 99.1% w/ LL v 97.2% w/o LL (p = NS). No major complications were observed in either group.


CONCLUSIONS
The use of a computer assisted navigation system significantly decreased the diagnostic, ablation, and total fluoroscopy times, as well as the number of energy applications, without affecting procedural success or complication rates. Non-radiologic navigation systems reduce radiation exposure during transcatheter electrophysiologic procedures and thus lower the lifetime radiation cumulative risk, a goal particularly important in children.
Papez
Andrew L
AL
University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI 48109-0204, USA. apapez@med.umich.edu
Al-Ahdab
Mohamad
M
Dick
Macdonald
M
Fischbach
Peter S
PS
D000293:Adolescent; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000379:methods; D004781:Environmental Exposure / Q000009:adverse effects / Q000517:prevention & control*; D005260:Female; D005471:Fluoroscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000601:surgery; D014965:X-Rays / Q000009:adverse effects*