Electroanatomic mapping‐guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy

Abstract

Introduction Atrial tachycardia (AT) is an uncommon cause of supraventricular tachycardia in children and it is often resistant to medical therapy. Catheter ablation can be curative in children with AT. However, experience of ablation of pediatric AT is still very limited. The aim of this study, which is the largest series from a single center, was to assess the efficacy and safety of ablation of AT using an electroanatomical‐mapping system. Methods It was a retrospective review of 39 children with AT who underwent catheter ablation procedure using the EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA) between July 2012 and April 2017. Results The mean patient age was 13.32 ± 6.82 years. The location of AT was right sided in 25 and left sided in 13, and both sides in one patient. The mean procedure time was 184.23 ± 60.19 min. Fluoroscopy was not used in 25 of 39 patients. The mean fluoroscopy time in the remaining patients was 5.53 ± 5.22 min. Radiofrequency (RF) ablation was used in 22, cryoablation was used in 10, and both RF and cryoablation were used in seven. Acute success was achieved in 34 patients (87.2%). During a mean follow‐up of 51.35 ± 12.62 months, AT recurred in five patients. These patients underwent second ablation procedures and four of them were successful. Final success was achieved in 33 out of 39 patients (84.6%). There were no complications except for one patient who had an uneventful pericardial needle injury during transseptal puncture without effusion. Conclusions Catheter ablation of AT in children can be performed safely and effectively with a limited fluoroscopy using electroanatomical mapping systems.

Zero‐fluoroscopy transseptal puncture guided by right atrial electroanatomical mapping combined with intracardiac echocardiography: A single‐center experience

“…Three-dimensional EAM has been used in association with catheter ablation for atrioventricular nodal reentrant tachycardia, cavotricuspid isthmus-dependent atrial flutter, and premature ventricular contraction, especially in pediatric and pregnant patients. [12][13][14][15][16][17] Three-dimensional EAM holds promise as a tool for use in combination with transseptal puncture.…”

State of Fluoroless Procedures in Cardiac Electrophysiology Practice

“…These fluoroless procedures are exceedingly significant in specific patient subpopulations who are at a higher risk of adverse effects from radiation exposure such as pregnant women, patients with obesity, and pediatric patients. 4,7,8,[10][11][12][13][14][15] In this review, we sought to describe how fluoroless procedures are carried out and highlight the new tools available to EP operators in this area of practice. In addition, we present the most recent data on fluoroless procedure outcomes.…”

Transcatheter ablation using near-zero fluoroscopy in children with focal atrial tachycardia: a single-centre experience

“…Although focal atrial tachycardia is generally benign, timely diagnosis and appropriate treatment are of utmost importance because focal atrial tachycardia can be incessant and lead to tachycardia-induced cardiomyopathy in a substantial number of patients. [1][2][3][4][5][6] Patients with focal atrial tachycardia are often resistant to pharmacological therapy and tend to respond well to transcatheter ablationa well-established, safe, and feasible option regarded as the treatment of choice in adult patients with focal atrial tachycardia. [6][7][8] Nonetheless, there remain limited data on transcatheter ablative therapy in children with focal atrial tachycardia; the studies that do exist include a few case series and one multicentre study.…”

“…[6][7][8] Nonetheless, there remain limited data on transcatheter ablative therapy in children with focal atrial tachycardia; the studies that do exist include a few case series and one multicentre study. [1][2][3][4][5] The radiation burden from the fluoroscopy employed for catheter navigation in ablation procedures has been an important disadvantage, especially in children who are known to be more susceptible to ionising radiation. 9 Three-dimensional electroanatomic mapping systems have emerged as a feasible alternative for catheter navigation, substantially decreasing the fluoroscopy used in ablation procedures.…”

“…Nevertheless, experience is limited with transcatheter ablation procedures performed via three-dimensional mapping systems in children with focal atrial tachycardia. [1][2][3][4][5] In this study, we aimed to demonstrate the outcome of transcatheter ablation procedures performed through three-dimensional electroanatomic mapping systems using minimal fluoroscopy in a paediatric cohort with focal atrial tachycardia. To the best of our knowledge, this study comprises the largest series of children with focal atrial tachycardia undergoing transcatheter ablation with acute and midterm outcomes at a single centre.…”