Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation

Abstract

Background Catheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective This study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia. Results In total, we included 223 patients, aged 14 (IQR 12–16) years; weighting 56 (IQR 47–65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20–41) versus 45 (IQR 29–65) mGy, P = 0.040). Conclusion In pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.

Efficacy and safety between radiofrequency ablation and types of cryoablation catheters for atrioventricular nodal reentrant tachycardia: A Network Meta‐analysis and Systematic Review

“…Consequently, our final analysis included 27 studies 7–9,16–39 (7 randomized studies and 20 observational studies analyzing 5110 patients who have AVNRT indicated for ablation. Cryoablations were performed 25 studies which categorized into 10 studies with 4‐mm tip catheter, 12 studies with 6‐mm tip catheter, and 3 studies with 8‐mm tip catheter.…”

“…A total of 27 studies 7–9,16–39 with retrievable information were considered for analysis. We conducted a descriptive assessment to evaluate the acute procedural success rate for each technique.…”

“…An analysis was conducted on a total of 27 studies 7–9,16–39 to assess the long‐term procedural success rates for each technique. Across all available studies, the overall success rates ranged from 72.22% to 100%.…”

“…A total of 21 studies 8,9,[17][18][19][20][21][22][23][24][25][26][27][28][31][32][33]35,36,38,39 were included in the analysis of permanent AV block, involving 3894 patients. While there were no specific reports on the management of AV block, we inferred that a permanent pacemaker would likely be necessary for most cases of permanent AV block.…”