Single Center Experience of Fluoroless AVNRT Ablation Guided by Electroanatomic Reconstruction in Children and Adolescents

Scaglione, Mariano; Ebrille, Elisa; Caponi, Domenico; Blandino, Alessandro; Donna, Paolo Di; Siboldi, Alessandra; Bertero, Giovanni; Anselmino, Matteo; Rabascio, Cristina; Sardi, Davide; Gabbarini, Fulvio; Marasini, Maurizio; Gaïta, Fiorenzo

doi:10.1111/pace.12183

Cited by 29 publications

(19 citation statements)

References 42 publications

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“…Diagnostic catheters were positioned in His bundle region, right ventricular apex and coronary sinus through a venous femoral approach. Recently, NavX (St. Jude Medical, St. Paul, MN, USA) system was used in order to minimize the use of fluoroscopy and to perform a right atrium electroanatomical map [17].…”

Section: Electrophysiological Study and Cryoablation Proceduresmentioning

confidence: 99%

Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation

Matta

Anselmino

Scaglione

et al. 2016

J Interv Card Electrophysiol

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Purpose. Catheter ablation of the slow pathway is the most effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). Cryoenergy, compared to radiofrequency, relates to lower heart block risk, but higher incidence of AVNRT recurrences. The aim of this study is to confirm safety and efficacy of AVNRT cryoablation and to identify predictors of long-term recurrences. Conclusions. AVNRT cryoablation is safe and effective. Long-term recurrence rate was 11.7%. An ablation approach directed to the complete elimination of dual AV node physiology, along with assessment of tissue's cooling dynamics, hold the potential to improve long-term AVNRT cryoablation efficacy. Methods andAbstract word count: 244 2

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Section: Electrophysiological Study and Cryoablation Proceduresmentioning

confidence: 99%

Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation

Matta

Anselmino

Scaglione

et al. 2016

J Interv Card Electrophysiol

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“…In 2013, Scaglione et al studied the feasibility of a fluoroless cryoablation in 21 children symptomatic for AVNRT [31]. They combined the advantages of the cryoablation with those ones of the electroanatomical mapping systems.…”

Section: Discussionmentioning

confidence: 99%

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

Casale¹,

Mezzetti²,

Tulino³

et al. 2017

J Neonatal Biol

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Introduction: Cardiac arrhythmias are challenging conditions in pediatric patients, especially in the case of newborns. Most of the tachyarrhythmias in children (90.24%) are atrioventricular reentrant tachycardias (AVRT) and atrioventricular nodal reentrant tachycardias (AVNRT). Although the standard 12-lead ECG maintains high diagnostic value, an invasive electrophysiological study with catheter ablation are often required. Unfortunately these procedures are burdened by the use of radiations. Materials and methods:We performed a systematic research in PubMed and Embase. We found 257 articles of interest but we selected only 36 as the most representative. Discussion:The main concerns linked to electrophysiological procedures are the need of fluoroscopy and thus the risk of malignancy as well as dermatitis, cataracts, thyroid diseases and birth defects in the patients' offspring. Children and especially newborns have a greater life expectancy so their cumulative risk is greater than adults. For this reason the guiding principle in electrophysiological procedures involving radiations in pediatric subjects is "as low as reasonably achievable" (acronym: ALARA). The development of 3-dimensional (3-D) electroanatomical mapping systems allowed a significant reduction of radiation exposure during catheter ablations. The most recent experiences demonstrated the feasibility and the safety of fluoroless ablation procedures of the most common arrhythmias in children.Conclusions: Cardiac arrhythmias could be very challenging conditions in pediatric patients. Predictors of complications are body weight <15 kg and age <4 years so it is clear that newborns are the most difficult patients. It is reasonable, because of these evidences, to approach cardiac arrhythmias pharmacologically in younger subjects. More than 20 years of experiences conducted by the electrophysiologists allow us to encourage the use of the electroanatomical mapping systems, with the objective of reducing the radiation exposure in children, especially when accessory pathways are involved. Citation: Casale M, Mezzetti M, Tulino V, Morelli M, Ciccarelli I, et al. (2017)

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“…With the accuracy offered by this modality, it should be a natural progression towards minimizing/completely eliminating fluoroscopy from most cardiac ablation procedures. However, although the use of fluoroless ablation of supraventricular arrhythmias is being aggressively pursued in the pediatric population, 5,[10][11][12][13] fluoroless ablation in the adult patient has been described in only a few studies from Europe, and with limited data from the United States. Kerst et al 14 presented an observational series of 30 patients, including 12 children, 29 of whom underwent successful fluoroless ablation for right and left atrial arrhythmias using a contact force-sensing catheter, and ICE imaging for CS cannulation.…”

Section: Discussionmentioning

confidence: 99%

Fluoroless Radiofrequency Ablation of Typical Cavotricuspid Isthmus-dependent Atrial Flutter is a Safe and Practical Procedure

Gautam¹

2015

JICRM

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ABSTRACT. Electrophysiologic procedures, including radiofrequency ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter, typically require varying amounts of fluoroscopy, which could be completely eliminated with electroanatomic mapping. We compared 20 consecutive patients who underwent fluoroless ablation for atrial flutter (Group A) with a prior series of 20 patients with standard flutter ablation (Group B). CARTO 3 mapping software was used to position diagnostic and ablation catheters in Group A; the ablation catheter was used to create a shell of the right atrium and coronary sinus (CS), and to guide CS catheter positioning. Atrial flutter was ablated successfully and bidirectional CTI block achieved without complication in all patients in both groups. Mean fluoroscopic duration and dose in Group B was 6.3 ± 3.3 min and 138±119 mGy respectively. There was no difference between Group A and Group B in procedure duration (110.2 ± 43.1 versus 114.9 ± 29.2 minutes, p ¼ 0.69), ablation duration (15.0 ± 11.7 versus 17.2 ± 10.1 min, p ¼ 0.52), time to ablation start (40.4 ± 13.3 versus 41.9 ± 14.8 min, p ¼ 0.74), and time from CS catheter insertion to optimal placement (5.4±4.4 versus 6.3±5.0 minutes, p ¼ 0.74). There was also no significant difference in these parameters between the first and last 10 patients in Group A. Fluoroless ablation for right atrial CTI-dependent flutter is safe and practical, with obvious advantages of avoidance of radiation exposure to patients and staff. Further studies are warranted applying these principles to other arrhythmia substrates.

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Single Center Experience of Fluoroless AVNRT Ablation Guided by Electroanatomic Reconstruction in Children and Adolescents

Abstract: Background. Anatomical considerations and risks related to x-ray exposure make atrio-

Cited by 29 publications

References 42 publications

Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation

Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation

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

Fluoroless Radiofrequency Ablation of Typical Cavotricuspid Isthmus-dependent Atrial Flutter is a Safe and Practical Procedure

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