Low-Temperature Mapping Predicts Site of Successful Ablation While Minimizing Myocardial Damage

Jm, Cote; Mr, Epstein; Jk, Triedman; Ep, Walsh; Jp, Saul

doi:10.1161/01.cir.94.3.253

Cited by 26 publications

(8 citation statements)

References 13 publications

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“…2,3 Accordingly, a number of authors have recommended modifications for RFCA procedures in small children without reliance on specific data obtained from human studies. 1,4,7,11 Procedural modifications, like limiting catheter caliber and tip size, could not be validated in this study because of institutional bias towards the use of smaller catheters, particularly in the ORT group. However, the present study did clearly demonstrate that when indexed for body size, application number and application duration are related to complication occurrence during RFCA for ORT in a high risk group of children under 15 kg.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnoses were orthodromic reciprocating tachycardia (ORT) in nine patients/nine studies, chaotic atrial tachycardia (CAT) in one patient/two studies, and VT in four patients/seven studies. RFCA variables included maximum temperature (69 • C, 50-78), total applications (10, 2-21), applications > 20 seconds (5,(0)(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), and total application time (331 s, 26-1,006 s). Complications were pericardial effusion in 1 patient, mild mitral regurgitation in 1, and myocardial infarction in 1 patient.…”

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confidence: 99%

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Radiofrequency Catheter Ablation in Small Children:

Blaufox¹,

Paul²,

Saul³

2004

Pacing Clinical Electrophis

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Little data exists to support the use of procedural modifications during radiofrequency catheter ablation (RFCA) in small children. A single institution database was reviewed for patients under 15 kg undergoing RFCA from January 1998 to August 2001. Of 268 RFCA procedures, 18 were done in 14 patients under 15 kg (median weight 5.7 kg, 3.5-13.7; age 5.8 months, 1.2-19.8). Six patients had normal hearts, 4 had congenital heart disease, and 4 patients had cardiomyopathy. Diagnoses were orthodromic reciprocating tachycardia (ORT) in nine patients/nine studies, chaotic atrial tachycardia (CAT) in one patient/two studies, and VT in four patients/seven studies. RFCA variables included maximum temperature (69 degrees C, 50-78), total applications (10, 2-21), applications > 20 seconds (5, 0-15), and total application time (331 s, 26-1,006 s). Complications were pericardial effusion in 1 patient, mild mitral regurgitation in 1, and myocardial infarction in 1 patient. When indexed for weight, the number of applications with a duration > 20 seconds in the ORT group was significantly greater in complicated versus uncomplicated procedures (0.7 applications/kg vs 0.16 applications/kg, P = 0.05). In addition, for the ORT subgroup, the indexed total application time trended higher in complicated versus uncomplicated procedures (40.6 s/kg, vs 6.6 s/kg, P = 0.1). RFCA success was 9/9 in ORT, 6/7 in VT, and 0/2 in CAT. RFCA can be successful in small children; however, complications appear to be related to RF dose indexed for body size. Thus, the decision to proceed with RFCA, and the application duration and number should be guided by patient size, balanced against the risks of the arrhythmia, and reserved for dire circumstances.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Radiofrequency Catheter Ablation in Small Children:

Blaufox¹,

Paul²,

Saul³

2004

Pacing Clinical Electrophis

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“…Furthermore, "test" RF applications with a lower-temperature set point (50°C) and short duration (5 seconds) can be used to limit tissue damage to the single location at which success is achieved. 25,26 Application times can then be extended to 15 to 30 seconds only if both AP conduction is lost and AV conduction is preserved. Despite lack of conclusive proof regarding these techniques, similar modifications have been used and reported elsewhere by centers contributing to the registry.…”

Section: Infant Procedures Modificationsmentioning

confidence: 99%

Radiofrequency Catheter Ablation in Infants ≤18 Months Old

Blaufox

Felix²,

Saul³

2001

Circulation

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Participating Members of the Pediatric Catheter Ablation Registry* Background-The objective of this study was to determine the indications, the safety, and the efficacy of pediatric radiofrequency catheter ablation (RFCA) in infants. Methods and Results-Data from the pediatric RFCA registry were reviewed. Between August 1989 and January 1999, 137 infants, defined by age 0 to 1.5 years (median 0.7 years; weight 1.9 to 14.8 kg, median 10 kg), underwent 152 procedures in 27 of 49 registry centers (55%), compared with 5960 noninfants undergoing 6610 procedures during a comparable period. Structural heart disease was present in 36% of infants, compared with 11.2% of noninfants (PϽ0.0001). RFCA in infants was performed more commonly for drug resistance or life-threatening arrhythmias than in noninfants. No differences were found between infants and noninfants in success for all tachycardia substrates (87.6% versus 90.6%, Pϭ0.11), for single accessory pathways (94.5% versus 91.5%, Pϭ0.4), or for total (7.8% versus 7.4%, Pϭ1) and major (4.6% versus 2.9%, Pϭ0.17) complications. Neither success for infants with a single accessory pathway nor complications for the entire infant group were related to weight, age, center size, or the presence of structural heart disease. Centers that performed infant procedures, however, enrolled more patients overall in the registry than those that did not perform infant procedures, and successful procedures in infants were performed by more experienced physicians than failed procedures. Conclusions-Compared with noninfants, RFCA in infants is usually performed for drug resistance or life-threatening arrhythmias, often in the presence of structural heart disease. The data support the use of RFCA by experienced physicians in selected infants. (Circulation. 2001;104:2803-2808.)

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“…Cryoablation has certain advantages over radiofrequency ablation in the clinical setting 1–7 . Cryoablation affords absolute catheter stability during energy delivery and yields sharply demarcated lesions 1 .…”

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confidence: 99%