Abbreviated combined anatomical/electrophysiological approach for catheter ablation of atrioventricular nodal reentrant tachycardia in children

Abstract

Atrioventricular nodal reentrant tachycardia was proven during electrophysiologic study in 41 children, aged from 3.7 to 16 years, who were referred for catheter ablation of symptomatic supraventricular tachycardia. Using an abbreviated combined anatomical and electrogram-guided approach for selective ablation of the slow pathway, a steerable ablation catheter was placed at the inferior region of the vestibule of the tricuspid valve close to the orifice of the coronary sinus, with the intention of recording a multicomponent local atrial electrogramm during sinus rhythm. If application of radiofrequency current of 500 kHz at 70 degrees C at this site did not result in a slowly accelerated junctional rhythm, at a rate of less than 120 beats per minute, the catheter was stepwise advanced up to a position midway towards the apex of the triangle of Koch for additional applications of energy. Ablation was achieved in 35 of the patients. In 6 patients, the slow pathway was modulated such that the tachycardia could no longer be induced. The number of applications of energy ranged from 1 to 19, with a median of 6 applications. The mean period of fluoroscopy was reduced to 15.6 (4.3 to 39.8) minutes, while the overall duration of the catheterization procedures ranged from 88 to 280 (mean 173.2) minutes. In none of the patients did we observe permanent high grade atrioventricular block. During follow-up over a mean of 4.1 years, two patients had recurrence of tachycardia, corresponding to a 95% rate of success in the midterm. We conclude that selective radiofrequency ablation of the slow pathway using the abbreviated anatomical and electrophysiological approach is a safe and curative therapeutic approach in children with atrioventricular nodal reentrant tachycardia. Periods required for fluoroscopy can be significantly reduced, and mid-term results are excellent.

Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents

“…Overall, there was a recurrence rate of 9.1%, which is within the range of 6 to 12% given in the literature . In accordance with the literature, there was a very low recurrence rate of 2.9% in patients with AVNRT , but higher recurrence rates for patients with AVRT or VT . Besides, recurrence rates were significantly higher in right lateral AP, which corresponds well to previous studies reporting higher recurrence rates after ablation of the right free wall AP compared with the left AP .…”

“…Accessory pathways of the right free wall were ablated less successfully compared with the left AP, which is most probably explained by the higher difficulty of finding a stable position for the ablation catheter . Besides, there was a high success rate of 97.2% in children with AVNRT, which also corresponded well to the results reported by several authors (, ). Overall, these findings demonstrate that RFCA has become a remarkably successful treatment for arrhythmia in children.…”

The Most Common Site of Success and Its Predictors in Radiofrequency Catheter Ablation of the Slow Atrioventricular Nodal Pathway in Children

“…Recent research has indicated that a combined electrophysiologic and anatomical mapping approach with catheter ablation of the slow pathway can safely and effectively treat atrioventricular nodal reentrant tachycardia (AVNRT) 1–3 . In adults, a site near the coronary sinus ostium along the tricuspid annulus has generally been adopted as the slow pathway target site.…”

“…In adults, a site near the coronary sinus ostium along the tricuspid annulus has generally been adopted as the slow pathway target site. Although pediatric references generally support this approach, 1,2 , 4–12 to our knowledge, no studies have specifically examined its appropriateness in developing children.…”

“…Recent research has indicated that a combined electrophysiologic and anatomical mapping approach with catheter ablation of the slow pathway can safely and effectively treat atrioventricular nodal reentrant tachycardia (AVNRT). [1][2][3] In adults, a site near the coronary sinus ostium along the tricuspid annulus has generally been adopted as the slow pathway target site. Although pediatric references generally support this approach, 1,2,[4][5][6][7][8][9][10][11][12] to our knowledge, no studies have specifically examined its appropriateness in developing children.…”