title: Success rates in pediatric WPW ablation are improved with 3-dimensional mapping systems compared with fluoroscopy alone: a multicenter study.
abstract: BACKGROUND
  Three-dimensional mapping (3-D) systems are frequently used for ablation of supraventricular tachycardia. Prior studies have demonstrated radiation dosage reduction with 3-D, but there are no data on whether 3-D improves the efficacy of ablation of Wolff-Parkinson-White syndrome (WPW). We sought to determine if 3-D improves the success rate for ablation of WPW in children.
  
  
  METHODS
  Multicenter retrospective study including patients ≤21 years of age with WPW undergoing ablation from 2008 to 2012. Success rates using the 2 techniques (3-D vs. fluoroscopy alone [FLUORO]) were compared.
  
  
  RESULTS
  Six hundred and fifty-one cases were included (58% male, mean age 13 ± 4 years, 366 [56%] 3-D). Baseline characteristics including gender, weight, accessory pathway (AP) location, number of APs, and repeat ablation attempts were similar between the 2 groups (3-D and FLUORO) The 3-D group was slightly younger (12.7 ± 4.0 vs. 13.3 ± 4.0 years; P = 0.04) and less likely to undergo ablation utilizing cryoenergy (38 [10%] vs. 56 [20%]; P < 0.01). The 3-D group had a higher acute success rate of ablation (355 [97%] vs. 260 [91%]; P < 0.01). No differences were seen in recurrence (16 [5%] vs. 26 [9%]; P = 0.09) or complication rates (1 [0.3%] vs. 1 [0.4%]; P = 0.86) between the groups. On multivariable analysis, 3-D was shown to significantly improve success at ablation with an odds ratio of 3.1 (95% CI 1.44-6.72; P < 0.01).
  
  
  CONCLUSIONS
  Use of 3-D significantly improved success rates for ablation of WPW in children. The increase in acute success associated with 3-D suggests it is an important adjunct for catheter ablation of WPW in children.
authors.affiliation: Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
authors.affiliation: Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Dubin
authors.affiliation: Department of Pediatric Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Department of Pediatric Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
authors.forename: Santiago O
authors.initials: SO
authors.lastname: Valdes
authors.affiliation: Department of Pediatrics, Miami Children's Hospital, Miami, Florida, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Fishberger
authors.affiliation: Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, USA.
authors.forename: Ira
authors.initials: I
authors.lastname: Shetty
authors.affiliation: Department of Pediatrics, Advocate Children's Hospital, Oak Lawn, Illinois, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Zimmerman
authors.affiliation: Department of Pediatrics, UCSF School of Medicine, UCSF Benioff Children's Hospital, San Francisco, California, USA.
authors.forename: Ronn E
authors.initials: RE
authors.lastname: Tanel
authors.affiliation: Department of Pediatrics, Maine Medical Center, Portland, Maine, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Epstein
authors.affiliation: Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA.
authors.forename: Kara S
authors.initials: KS
authors.lastname: Motonaga
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Capone
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nappo
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York, USA.
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Gates
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, The Children's Hospital at Montefiore, Bronx, New York, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
mesh_terms: D000200:Action Potentials; D000293:Adolescent; D000367:Age Factors; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D016009:Chi-Square Distribution; D002648:Child; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D005471:Fluoroscopy; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014927:Wolff-Parkinson-White Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: 3-D mapping; WPW; ablation; children; pediatrics