The high‐density grid catheter: A safe adjunctive tool in pediatric and complex congenital heart disease patients

Abstract

Introduction:The safety and utility of the Advisor™ High-Density Grid mapping catheter (HDGC) in children and congenital heart disease (CHD) patients are not well described.Methods: A single-center retrospective cohort study of pediatric and CHD patients undergoing electrophysiology study and ablation to determine the effect of HDGC use on outcomes including complications, fluoroscopy use, procedure duration, acute ablation success, and arrhythmia recurrence.Results: HDGC was used in 74/261 (28.3%) cases. HDGC subjects differed by median age (17 vs. 13 years; p < 0.001), weight (68 vs. 50 kg; p < 0.001), and prevalence of significant CHD (42% vs. 3%; p < 0.001). Arrhythmia substrates were dissimilar: HGDC cases had higher frequencies of intra-atrial re-entrant tachycardia (25.7% vs. 0.5%), atrial flutter (8.1% vs. 1.1%), ectopic atrial tachycardia (13.5% vs.3.7%), and premature ventricular contractions (9.5% vs. 0.5%), and lower incidences of atrioventricular re-entrant tachycardia (16.2% vs. 46.1%). Complications were rare (n = 5, 1.9%) with no significant difference between groups (p = 1.00). Procedure duration-but not fluoroscopy exposure-was significantly longer in HDGC cases (median 256 vs. 216 min, p < 0.001). Acute success was lower (93.2% vs. 99.4%; p = 0.01) and recurrences higher (13.2% vs. 3.8%; p = 0.016) in HDGC compared to non-HDGC cases.Conclusion: HDGC use in children and CHD patients is safe and not associated with higher complication rates. The lower acute success and higher recurrence rates in HDGC cases likely reflect a bias toward HDGC use in more complex arrhythmia substrates rather than less favorable ablation outcomes.ablation, congenital heart disease, high-density grid catheter, pediatric | INTRODUCTIONCatheter ablation is considered first-line therapy for many pediatric arrhythmias. Although catheter technology used in pediatric and adult ablations are often identical, the application of some technologies in children is limited by patient size and unique anatomic and biophysical considerations. 1,2 As a result, children undergoing catheter ablations may not always derive benefit from the newest innovations in interventional electrophysiology (EP) available to adults. Thus, pediatric experience with new technologies is important.

Automated isochronal late activation mapping for substrate characterization in patients with repaired tetralogy of Fallot

“… 20 The use of HDGC has been previously evaluated in miscellaneous paediatric and congenital heart disease populations, resulting in a high-density mapping with lower procedure time and without complications associated with its use. 15 Our series shows a population of patients with rTF evaluated both in secondary and primary prevention for VT and represents the largest study using HDGC in this scenario. In this population, high-density maps were obtained in adequate mapping and revision times (mean 29.5 min) without complications.…”

“…A ‘paint brush’ mapping technique was applied as previously described by others. 15 Attention was given to assess the utility and safety of HDGC in terms of accuracy, efficacy, and procedure time. A bipolar electrogram voltage <1.5 mV was considered abnormal.…”

“… 14 Although this technology has been validated in many circumstances, resulting in shorter procedure times and superior arrhythmia free survival, data about its systematic use for VT substrate characterization in rTF are lacking. 2 , 15 …”

Intracardiac echocardiography in paediatric and congenital cardiac ablation shortens procedure duration and improves success without complications

“…Ablation was considered acutely successful if the targeted arrhythmia substrate was eliminated and non-inducible during the 30–60 min observation period after final energy application. 8 Procedural complications included: any mortality or significant morbidity including vascular and/or valvar injury, heart block, pericardial effusion, and coronary artery injury. Post-procedural electrocardiogram (ECG) was used to assess for coronary artery injury.…”