title: Tricking CARTO: Cryoablation of Supraventricular Tachycardia in Children with Minimal Radiation Exposure Using the CARTO3 System.
abstract: BACKGROUND
  CARTO3 is frequently used during ablation but is not designed to allow visualization of non-CARTO3 ablation catheters. We describe how cryoablation catheters can be visualized and recorded using CARTO3 with minimal fluoroscopy (FLUORO) usage.
  
  
  METHODS
  Retrospective review of patients ≤21 years undergoing cryoablation with CARTO3 from 2010 to 2013 for ablation of supraventricular tachycardia. After mapping with a Navistar catheter, the Navistar was removed and a cryocatheter was utilized. The cryocatheter was connected to the pin box via a jumper cable and the pin box was connected to the CARTO3 patient interface unit. Locations of ablation attempts with the cryocatheter were recorded with the "Create Snapshot" tool. Clinical characteristics and radiation doses were compared between patients undergoing cryoablation (cryoenergy [CRYO]) to an age- and diagnosis-matched control group (CONTROL) undergoing RF ablation.
  
  
  RESULTS
  A total of 174 ablations were performed and 14 patients underwent cryoablation (CRYO, 13.3 ± 4.7 years, weight 42 ± 14 kg). Indications for cryoablation were: five atrioventricular nodal reentry tachycardia (36%), four ectopic atrial tachycardia (29%), three concealed accessory pathways (21%), and two Wolff-Parkinson-White syndromes (14%). Acute success was achieved in all patients (100%) with no complications and one recurrence (7%). The site of successful cryoablation was successfully recorded on the CARTO3 system in all cases. Radiation doses were low and not different from an age-, era-, and diagnosis-matched control group undergoing RF ablation (CRYO 3.2 ± 0.8 mGy vs CONTROL 1.6 ± 0.4 mGy, P = 0.07).
  
  
  CONCLUSIONS
  Though a "closed" system, CARTO3 can be "tricked" to allow for the use of cryoablation, allowing clear catheter visualization, mapping, and recording of ablation lesions with minimal FLUORO usage.
authors.affiliation: Pediatric Electrophysiology, Department of Pediatrics, Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Ceresnak
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Pediatric Arrhythmia Service, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, New York.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nappo
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Pediatric Arrhythmia Service, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, New York.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Janson
authors.affiliation: Department of Pediatrics, Division of Pediatric Cardiology, Pediatric Arrhythmia Service, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, New York.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pass
mesh_terms: D000293:Adolescent; D002648:Child; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D005471:Fluoroscopy / Q000295:instrumentation / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation* / Q000379:methods; D008297:Male; D000069079:Radiation Exposure / Q000032:analysis* / Q000517:prevention & control*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D013617:Tachycardia, Supraventricular / Q000601:surgery*; D016896:Treatment Outcome; D014965:X-Rays
keywords: 3D mapping; CARTO3; ablation; children; cryoablation; pediatrics; radiation reduction