Zero-Fluoroscopy Ablation of Accessory Pathways in Children and Adolescents: CARTO3 Electroanatomic Mapping Combined with RF and Cryoenergy.
BACKGROUND
Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients to the potential risk of radiation considering the sensitivity of this population and its longer life expectancy. We evaluated the feasibility, safety, and efficacy of accessory pathway (AP) ablation guided by CARTO3 electroanatomic mapping (EAM) system with both cryoenergy and radiofrequency (RF) energy in order to avoid x-ray exposure in pediatric patients.


METHODS
We included 44 patients (mean age: 13.1 ± 3.3 years); nine of 44 presented concealed AP. An electrophysiological study with a three-dimensional EAM reconstruction was performed in every patient with a venous transfemoral direct right atrium approach or an arterial transfemoral retrograde approach to reach the mitral annulus. In two patients with left-sided AP, the ablation was performed via a patent foramen ovale.


RESULTS
A total of 47 APs were present, left sided in 45% (21/47) of cases (15 lateral, one anterior, three posteroseptal, and two posterolateral) and right sided in 55% (26/47; one anterior, three anterolateral, one posterolateral, three lateral, five para-Hisian, 12 posteroseptal, and one anteroseptal). Ablation without the use of fluoroscopy was successfully performed in every patient (33 with RF and in 11 with cryoenergy). No complication occurred. At a mean follow-up of 16.0 ± 11.7 months, we observed seven recurrences, three of them successfully re-ablated without fluoroscopy. In one case cryoablation of a para-Hisian AP was ineffective in the long term.


CONCLUSIONS
Three-dimensional EAM allowed a safe and effective fluoroless AP ablation procedure in a pediatric population both with RF and cryoenergy.
Cardiology Division, Cardinal G. Massaia Hospital, Asti, Italy.
Marco
M
Scaglione
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
Elisa
E
Ebrille
Cardiology Division, Cardinal G. Massaia Hospital, Asti, Italy.
Domenico
D
Caponi
Pediatric Cardiology Department, G. Gaslini Institute, Genova, Italy.
Alessandra
A
Siboldi
Pediatric Cardiology Department, G. Gaslini Institute, Genova, Italy.
Giovanni
G
Bertero
Cardiology Division, Cardinal G. Massaia Hospital, Asti, Italy.
Paolo
P
Di Donna
Cardiology Department, OIRM Pediatric Hospital, Turin, Italy.
Fulvio
F
Gabbarini
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
Cristina
C
Raimondo
Cardiology Division, Cardinal G. Massaia Hospital, Asti, Italy.
Francesca
F
Di Clemente
Cardiology Division, Cardinal G. Massaia Hospital, Asti, Italy.
Paolo
P
Ferrato
Pediatric Cardiology Department, G. Gaslini Institute, Genova, Italy.
Maurizio
M
Marasini
Cardiology Division, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
Fiorenzo
F
Gaita
D058606:Accessory Atrioventricular Bundle / Q000601:surgery*; D000293:Adolescent; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D003452:Cryosurgery; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D061214:Patient Safety; D011846:Radio Waves; D016896:Treatment Outcome
Keywords; ablation; accessory pathway; cryoenergy; electroanatomic mapping system; fluoroless; pediatric