Fluoroless catheter ablation of various right and left sided supra-ventricular tachycardias in children and adolescents

Abstract

Electrophysiology study (EPS) and catheter ablation (CA) in children and adolescents carries a potentially harmful effect of radiation exposure when performed with the use of fluoroscopy. Our aim was to evaluate the feasibility, safety and effectiveness of fluoroless EPS and CA of various supra-ventricular tachycardias (SVTs) with the use of the 3D mapping system and intracardiac echocardiography (ICE). Forty-three consecutive children and adolescents (age 13 ± 3 years) underwent fluoroless EPS and CA for various supra-ventricular tachycardias. A three-dimensional (3D) mapping system NavX™ was used for guidance of diagnostic and ablation catheters in the heart. ICE was used as a fundamental imaging tool for transseptal punctures. Acute procedural success rate was 100 %. There were no procedure related complications and short-term follow up (10 ± 3 months) revealed 93 % arrhythmia free survival rate. Fluoroless CA of various SVTs in the paediatric population is feasible, safe and can be performed successfully with 3D mapping system and ICE.

Off the pedal: Fluoroless transseptal puncture in pediatric supraventricular tachycardia ablation

“…Jan et al. describe the feasibility of TS puncture in 11 pediatric patients with ICE guidance without procedural complications, though they do not report TS puncture times and do not utilize EA mapping concomitantly with ICE imaging. Our data give additional evidence of the feasibility of fluoroless TS puncture and the possible use of EA mapping as an adjunct in the future.…”

Electroanatomical mapping systems and cardiac arrhythmias: avoiding radiations in pediatric patients

“…The development of 3-dimensional (3-D) electroanatomical mapping systems allowed a significant reduction of radiation exposure during catheter ablations [18,19,29]. Currently there are two tools available in children: the EnSite system (St. Jude Medical, Inc.) and the CARTO system (Biosense Webster, Inc.).…”

“…Briefly the EnSite one is based on the measurement of the electrical impedances and the CARTO one on the measurement of magnetic fields deriving from heart ( Figure 3). These systems allow a reconstruction of the spatial geometry of the heart's chamber of interest and allow visualization of the ablation catheter in relation to the reconstructed model [18,19,29]. Recently a third system called Rhythmia (Boston Scientific) with highly accurate hybrid tracking, based both on magnetic and impedance technologies, was tested for mapping scar-related atrial tachycardias [30].…”

2019 APHRS expert consensus statement on three‐dimensional mapping systems for tachycardia developed in collaboration with HRS, EHRA, and LAHRS

“…Whenever the target chamber is not directly accessible, a transseptal or transbaffle puncture is necessary to gain access. Visualization of the transseptal access can be achieved with real‐time transesophageal echocardiography (TEE) or ICE, but require either an additional operator or additional vascular access . Recently, a number of groups have reported on visualizing the tip of the transseptal needle on the 3D mapping system allowing thereby a totally ZERO radiation ablation approach in AF ablation procedures (Figure 14‐2).…”

“…Visualization of the transseptal access can be achieved with real-time transesophageal echocardiography (TEE) or ICE, but require either an additional operator or additional vascular access. [336][337][338] Recently, a number of groups have reported on visualizing the tip of the transseptal needle on the 3D mapping system allowing thereby a totally ZERO radiation ablation approach in AF ablation procedures (Figure 14-2). 95,339 14.5 | Patient groups requiring low or ZERO fluoroscopy exposure…”