title: Patient and Procedural Correlates of Fluoroscopy Use During Catheter Ablation in the Pediatric and Congenital Electrophysiology Lab.
abstract: OBJECTIVE
  To identify factors associated with fluoroscopy use in pediatric and congenital heart disease (CHD) patients.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Pediatric electrophysiology lab in a single tertiary-care children's hospital.
  
  
  METHODS
  Three hundred eighty-three patients who underwent electrophysiology study and ablation between January 2010 and December 2012.
  
  
  METHODS
  Ablation procedures in which nonfluoroscopic navigation was employed were reviewed. Procedures using ≥ 10 minutes of fluoroscopy (high-fluoroscopy time; HF) were compared with those using <10 minutes (low-fluoroscopy time; LF). Group comparison of characteristics was made in the entire cohort and in CHD and anatomically normal heart subsets.
  
  
  RESULTS
  During the study period, 416 ablation procedures were performed involving 471 substrates in 383 patients. Median fluoroscopy time was 6.7 minutes overall and 5.1 minutes with anatomically normal hearts. LF comprised 61% of all ablation and 69% of anatomically normal hearts. LF procedures were associated with anatomically normal hearts (93% vs. 63%; P < .0001). In anatomically normal hearts, HF was associated with accessory pathways (64% vs. 47%; P = .01), posteroseptal substrates (22% vs. 9%; P = .002), and ventricular substrates (12% vs. 1%; P < .0001). All cases of intra-atrial reentrant tachycardia were HF. HF was associated with trans-septal puncture (47% vs. 23%; P < .0001) though not when controlling for atrioventricular nodal reentrant tachycardia. LF was associated with cryoablation (56% vs. 17%; P < .0001).
  
  
  CONCLUSIONS
  In pediatric and congenital EP, ablation procedures using cryoablation and in patients with anatomically normal hearts are associated with LF. In accessory pathway ablation, HF was not associated with trans-septal puncture.
authors.affiliation: Pediatrix Cardiology Associates of New Mexico, Albuquerque, NM, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Kean
authors.affiliation: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: LaPage
authors.affiliation: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
authors.forename: Sunkyung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
authors.forename: Macdonald
authors.initials: M
authors.lastname: Dick
authors.affiliation: Division of Pediatric Cardiology, University of Michigan, Ann Arbor, Mich, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Catheter Ablation; Electrophysiology; Fluoroscopy; Pediatric Cardiology