The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia.
OBJECTIVE
Non-fluoroscopic imaging (NFI) devices are increasingly used in ablations. The objective was to determine the utility of intracardiac echocardiography (ICE) in ablating paediatric supraventricular tachycardias (SVTs) and assess whether its integrated use with electroanatomic mapping (EAM) resulted in lower radiation exposure than use of EAM alone.


RESULTS
Prospective, controlled, single-centre study of patients (pts) age ≥10 years, weight ≥35 kg, with SVT and normal cardiac anatomy. Patients were randomized to ICE + EAM (ICE) or EAM only (no ICE). Both had access to fluoroscopy as needed. Eighty-four pts were enroled (42 ICE, 42 no ICE). Median age was 15 years (range 10.4-23.7 years); 57% had accessory pathways, 42% atrioventricular nodal reentry tachycardia. There was no difference in radiation dose (9 mGy ICE vs. 23 mGy no ICE, P = 0.37) or fluoroscopy time (1.1 min ICE vs. 1.5 min no ICE, P = 0.38). Transseptal punctures were performed in 25 pts (16 ICE, 9 no ICE), with ICE reducing radiation (8 mGy ICE vs. 62 mGy no ICE, P = 0.002) and fluoroscopy time (1.1 min ICE vs. 4.5 min no ICE, P = 0.01). Zero fluoroscopy was achieved in 13 pts (15% of total, 5 ICE, 8 no ICE), and low-dose cases (<50 mGy) in 57 pts (68% of total, 33 ICE, 24 no ICE). Acute success was 95% for ICE, 88% for no ICE.


CONCLUSIONS
Use of an integrated EAM/ICE system was no better than EAM alone in limiting radiation, but can be helpful for transseptal punctures. Given the low dose savings, use of ICE may be weighed against its financial cost. Low-fluoroscopy cases are performed in most NFI procedures.
Department of Cardiology, Boston Children's Hospital and the Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
Douglas Y
DY
Mah
Christina Y
CY
Miyake
Elizabeth D
ED
Sherwin
Amy
A
Walsh
Michael J
MJ
Anderson
Kara
K
Western
Dominic J
DJ
Abrams
Mark E
ME
Alexander
Frank
F
Cecchin
Edward P
EP
Walsh
John K
JK
Triedman
D000293:Adolescent; D000367:Age Factors; D001900:Boston; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011677:Punctures; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000009:adverse effects; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013617:Tachycardia, Supraventricular / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Ablation; Intracardiac echocardiography; Paediatrics; Radiation; Supraventricular tachycardia