title: Single center experience of fluoroless AVNRT ablation guided by electroanatomic reconstruction in children and adolescents.
abstract: BACKGROUND
  Anatomical considerations and risks related to x-ray exposure make atrioventricular nodal reentrant tachycardia (AVNRT) ablation in pediatric patients a concerning procedure. We aimed to evaluate the feasibility, safety, and efficacy of performing fluoroless slow-pathway cryoablation guided by the electroanatomic (EA) mapping in children and adolescents.
  
  
  METHODS
  Twenty-one consecutive patients (mean age 13.5 ± 2.4 years) symptomatic for AVNRT were prospectively enrolled to right atrium EA mapping and electrophysiological study prior to cryoablation. Cryoablation was guided by slow-pathway potential and performed using a 4-mm-tip catheter.
  
  
  RESULTS
  Sustained slow-fast AVNRT was inducible in all the patients with a dual AV nodal physiology in 95%. Acute success was achieved in 100% of the patients with a median of two cryo-applications. Fluoroless ablation was feasible in 19 patients, while in two subjects 50 seconds and 45 seconds of x-ray were needed due to difficult progression of the catheters along the venous system. After a mean follow-up of 25 months, AVNRT recurred in five patients. All the recurrences were successfully treated with a second procedure. In three patients, a fluoroless cryoablation with a 6-mm-tip catheter was successfully performed, while in the remaining two patients, a single pulse of 60 seconds of radiofrequency energy was applied under fluoroscopic monitoring. No complications occurred.
  
  
  CONCLUSIONS
  Combination of EA mapping systems and cryoablation may allow to perform fluoroless slow-pathway ablation for AVNRT in children and adolescents in the majority of patients. Fluoroless slow-pathway cryoablation showed a high efficacy and safety comparable to conventional fluoroscopy guided procedures.
authors.affiliation: Cardiology Department, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.forename: Elisa
authors.initials: E
authors.lastname: Ebrille
authors.forename: Domenico
authors.initials: D
authors.lastname: Caponi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Blandino
authors.forename: Paolo
authors.initials: P
authors.lastname: DI Donna
authors.forename: Alessandra
authors.initials: A
authors.lastname: Siboldi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bertero
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Cristina
authors.initials: C
authors.lastname: Raimondo
authors.forename: Davide
authors.initials: D
authors.lastname: Sardi
authors.forename: Fulvio
authors.initials: F
authors.lastname: Gabbarini
authors.forename: Maurizio
authors.initials: M
authors.lastname: Marasini
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
mesh_terms: D000293:Adolescent; D018780:Body Surface Potential Mapping / Q000379:methods*; D002648:Child; D003452:Cryosurgery / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000379:methods*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
keywords: AVNRT; cryoablation; electroanatomic mapping; fluoroscopy; pediatric population