title: Limited fluoroscopy catheter ablation of accessory pathways in children.
abstract: BACKGROUND
  Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children.
  
  
  METHODS
  Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP).
  
  
  RESULTS
  The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, p<0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications.
  
  
  CONCLUSIONS
  A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.
authors.affiliation: Kaplan Medical Center, Rehovot, The Hebrew University, Jerusalem, Israel. Electronic address: swissam@mail.huji.ac.il.
authors.forename: Moshe
authors.initials: M
authors.lastname: Swissa
authors.affiliation: The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Einat
authors.initials: E
authors.lastname: Birk
authors.affiliation: The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Tamir
authors.initials: T
authors.lastname: Dagan
authors.affiliation: Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Sody
authors.initials: S
authors.lastname: Abby Naimer
authors.affiliation: The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Fogelman
authors.affiliation: The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Tom
authors.initials: T
authors.lastname: Einbinder
authors.affiliation: The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Elchanan
authors.initials: E
authors.lastname: Bruckheimer
authors.affiliation: The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel.
authors.forename: Rami
authors.initials: R
authors.lastname: Fogelman
mesh_terms: D058606:Accessory Atrioventricular Bundle / Q000000981:diagnostic imaging* / Q000601:surgery*; D000293:Adolescent; D017115:Catheter Ablation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D012008:Recurrence; D014927:Wolff-Parkinson-White Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery*
keywords: Accessory pathway; Catheter ablation; Electro-anatomic mapping systems; Limited fluoroscopy; Wolf–Parkinson–White syndrome