title: Cryoablation therapy for atrioventricular nodal reentrant tachycardia in children: a multicenter experience of efficacy.
abstract: Atrioventricular nodal reentrant tachycardia (AVNRT), a common tachycardia in children, is routinely treated by catheter ablation using radiofrequency or cryothermal energy. Acute success rates of 95-97 % are reported for cryoablation, similar to those achieved with radiofrequency ablation (RFA). However, early studies reported higher recurrence rates after cryoablation for treatment of AVNRT than those reported for RFA. This study evaluated the success and recurrence rates for cryoablation in a current cohort of pediatric patients across several institutions. Patients 21 years old or younger with AVNRT who underwent cryoablation at five participating centers between 2004 and 2009 were retrospectively reviewed. Patient demographics and procedural data were extracted from patient records and analyzed. A total of 434 patients with AVNRT who underwent cryoablation were identified. Cryoablation was used as the exclusive ablation method for 379 patients. For 97 % (368/379) of these patients, cryoablation was acutely successful. A higher acute success rate was found with the 6-mm-tip catheter (99 %) than with the 4-mm-tip catheter (91 %) (p < 0.01). Recurrence was experienced by 7.3 % of the patients. Recurrence was more likely for those treated with the 4-mm-tip catheter (6/42, 14 %) than for those who had the larger catheters (12/204, 6 %) No patient experienced permanent heart block. Success and recurrence rates for this cohort of patients were similar to those reported for RFA used to treat AVNRT in pediatric patients. The findings show a higher success rate and a lower recurrence rate after cryoablation with a 6-mm-tip catheter than after use of the 4-mm-tip catheter, with an associated excellent safety profile.
authors.affiliation: Sibley Heart Center, Children's Healthcare of Atlanta, Emory University, 2835 Brandywine Road, Ste. 300, Atlanta, GA 30341, USA.
authors.forename: Srikant
authors.initials: S
authors.lastname: Das
authors.forename: Ian H
authors.initials: IH
authors.lastname: Law
authors.forename: Nicholas H
authors.initials: NH
authors.lastname: Von Bergen
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
authors.forename: Macdonald
authors.initials: M
authors.lastname: Dick
authors.forename: Susan P
authors.initials: SP
authors.lastname: Etheridge
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Saarel
authors.forename: Patricio A
authors.initials: PA
authors.lastname: Frias
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Strieper
authors.forename: Peter S
authors.initials: PS
authors.lastname: Fischbach
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult