title: Radiofrequency catheter ablation of left-sided accessory pathways in children using a new fluoroscopy integrated 3D-mapping system.
abstract: Advances in 3D electroanatomic-mapping technologies have resulted in a safe and effective profile of radiofrequency (RF) catheter ablation. The aim of this study was to evaluate a different catheter ablation approach in patients with left-sided accessory pathways (APs).
  
  
  
  From January 2015 to December 2015, 30 patients (median age 11 years, median weight 45 kg) with manifest or concealed left-sided APs underwent RF catheter ablation with a new protocol. All procedures were performed with the CARTO UNIVU™ system, integrating electroanatomic maps with fluoroscopic views. A 7 Fr ablation catheter was inserted into the right femoral vein and advanced into the right atrium. Geometrical reconstruction and activation map of the right atrium, tricuspid annulus, and coronary sinus were acquired. The ablation catheter was then inserted into the left femoral artery and advanced through the aorta and aortic valve, creating an activation map of the mitral annulus. Catheter ablation was targeted to the site of the earliest activation. No complications occurred. The median procedure and fluoroscopy times were 130 min and 6 s, with a median fluoroscopy dose 0.5 mGy. An average of two catheters was used. Long-term success rate was 97% (29/30) at a median follow-up of 9.6 months. This approach reduced fluoroscopy time, dose and number of catheters used compared with manifest or concealed left-sided AP ablation using CARTO 3™ (P < 0.05).
  
  
  
  This new ablation protocol seems to be promising in reducing fluoroscopy exposure and number of catheters used during left-sided AP ablation in children.
authors.affiliation: Pediatric Cardiology and Cardiac Arrhythmia-Syncope Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Drago
authors.forename: Gino
authors.initials: G
authors.lastname: Grifoni
authors.forename: Romolo
authors.initials: R
authors.lastname: Remoli
authors.forename: Mario Salvatore
authors.initials: MS
authors.lastname: Russo
authors.forename: Daniela
authors.initials: D
authors.lastname: Righi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pazzano
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Palmieri
authors.forename: Silvia
authors.initials: S
authors.lastname: Placidi
authors.forename: Fabio Anselmo
authors.initials: FA
authors.lastname: Saputo
authors.forename: Massimo Stefano
authors.initials: MS
authors.lastname: Silvetti
mesh_terms: D058606:Accessory Atrioventricular Bundle; D000200:Action Potentials; D000293:Adolescent; D000367:Age Factors; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D022062:Electrophysiologic Techniques, Cardiac / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006339:Heart Rate; D006801:Humans; D008297:Male; D061646:Operative Time; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure; D011857:Radiographic Image Interpretation, Computer-Assisted; D015641:Radiography, Interventional / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Ablation; Children; Electroanatomical mapping; Left-sided accessory pathway; Radiation exposure