Efficacy, Time, Cost and Radiation Exposure of Combined Limited Fluoroscopy with Non-fluoroscopic Three-dimensional Imaging in Paediatric Supraventricular Tachycardia Ablation – Best of Both Worlds

Abstract

Objective: Catheter ablation for supraventricular tachycardias (SVTs) traditionally has utilised fluoroscopic imaging (FI). However, radiation concerns have recently contributed to the evolution of non-fluoroscopic three-dimensional imaging (3DI) systems. A few recent studies have advocated non-FI in lieu of FI. To date, there are only a few studies reporting use of limited FI with 3DI usage in children undergoing SVT ablations. This study evaluates time, efficacy, cost and safety of limited FI plus 3DI for SVT ablation in the young.Methods: Electrophysiology study (EPS) and ablation data for standard forms of SVT from October 2009 to June 2012 were reviewed. Patient radiation time, radiation dose area product (DAP), EPS time, anaesthesia duration and cost, and ablation success rates were evaluated.Results: A total of 81 patients (mean age 13.2 ± 3.4 years) underwent ablation. Type of SVT, gender, age, acute success, adverse events and recurrences were recorded post-ablation for over 2.5 years. Acute procedural success was 93.8 %. Of these, chronic sustained success was 85.5 %. As expected, limited FI plus 3DI was associated with some radiation exposure (2.47 ± 2.78 milliGray-m2) but less than historically associated with paediatric tachycardia ablations.Conclusion: A conscious awareness to use limited FI combined with 3DI is associated with excellent long-term success, lack of complications and marked decrease in radiation exposure. Although 3DI-only has some appeal, use of combined limited radiation is associated with some advantages overall. Potential adverse effects of limited radiation need to be weighed in when deciding which imaging or combination to use.