Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience

Abstract

Objective:Fascicular tachycardia is a common form of sustained idiopathic left ventricular tachycardia. This study aimed to achieve successful results with catheter ablation procedures performed through three-dimensional electroanatomic mapping using near-zero fluoroscopy in fascicular tachycardia patients.Methods and results:In this study, we included 33 consecutive children with fascicular tachycardia, for whom we performed a transcatheter radiofrequency ablation procedure using the EnSite® system. Activation mapping was performed in all patients during tachycardia, and the earliest presystolic purkinje potentials were the target site for radiofrequency lesions.Results:Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg, and the mean age was 13.6 ± 2.5 years. The mean procedure time was 121.3 ± 44.3 minutes. The mean follow-up period was 18.4 ± 6.5 months. No fluoroscopy was needed in 30 patients. The mean fluoroscopy time in the remaining patients was 166.6 ± 80 seconds. All of the patients had left posterior fascicular tachycardia except for one who had left anterior fascicular tachycardia. The acute success rate was perfect (100%). No patients developed left bundle branch block or complete atrioventricular block. Recurrence developed in one patient.Conclusion:We suggest that radiofrequency ablations via an electroanatomic mapping system are quite safe and effective, with high success rates in paediatric patients with fascicular tachycardia. This method has the advantage of avoiding ionising radiation exposure for both the patient and operator, thus reducing the lifetime risk of malignancy in the paediatric population.

Idiopathic left fascicular ventricular tachycardia in children and adolescents

“…A recurrence rate of 20% and 3% was recorded during short-and long-term follow-ups. Repeat ablations achieved permanent success in all cases 24,25 . Only the last four cases were performed in our series with 3-D mapping after introducing this technology in our center.…”

“…In a small series of four patients with a mean age of 14.5 years (4-20 years), success was achieved in all cases using noncontact mapping (EnSite ArrayTM) 23 . Two recent studies with EnSite NavXTM totaling 53 children reported an acute success rate of 95% and 100%, with a median fluoroscopy time between 1.25 and 5.1 minutes 24,25 , although fluoroscopy was not used in 91% of cases 23 .…”

“…In most patients, catheter ablation has no severe acute or chronic complications. Still, minor complications have been described, such as persistent left bundle branch block (0.9%) 18 without major complications 19,20,[23][24][25] or permanent atrioventricular block. The latter was present in the uncommon left anterior fascial VT because, in some cases, it is located in the mid-anterior LV septum, close to the His-bundle 22 .…”

Ventricular tachycardia ablation in children

“…The major concern in catheter ablation in pediatric patients is procedural safety [ 7 ]. Several reports have confirmed the safety of VT catheter ablation in the pediatric population [ [8] , [9] , [10] , [11] ]. Most reports include idiopathic VT and common reentrant fascicular forms.…”

Safety and efficacy of zero-fluoroscopy catheter ablation for paroxysmal supraventricular tachycardia in Chinese children

“…In our study, the zero-fluoroscopy group had no radiation exposure during the entire ablation procedure or any loss of procedural efficacy or safety. Zero-fluoroscopy RFCA can completely avoid fluoroscopy exposure during ablation, thereby reducing the risk of malignancy in children (36,37). With the development of technology, people have an increasing need to lead a healthy life.…”