Zero‐Fluoroscopy Ablation of Accessory Pathways in Children and Adolescents: CARTO3 Electroanatomic Mapping Combined with RF and Cryoenergy

Scaglione, Mariano; Ebrille, Elisa; Caponi, Domenico; Siboldi, Alessandra; Bertero, Giovanni; Donna, Paolo Di; Gabbarini, Fulvio; Rabascio, Cristina; Clemente, Francesca Di; Ferrato, Paolo; Marasini, Maurizio; Gaïta, Fiorenzo

doi:10.1111/pace.12619

Cited by 40 publications

(21 citation statements)

References 27 publications

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“…Procedural success was achieved in 99.1% of cases and in 94.7% the procedure was completed without any fluoroscopy use at all. A wider experience has been recently reported by Scaglione et al 36 . In this series a total no fluoroscopic approach was used in 44 consecutive paediatric patients with planned accessory pathway ablation.…”

Section: Atrioventricular Re-entrant Tachycardia Reciprocating Atriomentioning

confidence: 75%

The dream of near-zero X-rays ablation comes true

et al. 2016

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Abstract:While radiation exposure related to natural sources plays a minor role, medicine-related exposure, represents, to date, a major exposure source. Within this exposure interventional electrophysiology is a relevant contributor. Unfortunately no safe dose in radioprotection exists, the negative acute and long term effects of radiological exposure may emerge at any radiation exposure dose. For this reason patients and physicians should be aware of the risk of radiation exposure and the benefits of the imaging/procedure balanced by the required radiation exposure. Given this, performing a near to zero x-rays transcatheter ablation procedure should therefore represent an aim for all electrophysiological lab. Fortunately, the introduction of electroanatomic mapping systems, have provided the possibility to perform simple and complex electrophysiological procedures avoiding, or at least, limiting the use of radiations. The present review summarizes state of the art of feasibility and safety of the near to zero approach for the main electrophysiological procedures, highlighting the potential health benefits.3

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Section: Atrioventricular Re-entrant Tachycardia Reciprocating Atriomentioning

confidence: 75%

The dream of near-zero X-rays ablation comes true

et al. 2016

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“…The reduction in the procedure time is because of the continuous imaging and mapping using 3DS. Though, Scaglione et al reported a zero fluoroscopy time in 44 children with AP using the CARTO‐3 mapping system with an acute success rate of 100%, it was associated with a high recurrence rate of 16% (7/44) and the use of a retrograde approach instead of a trans‐septal approach for children with LSAP.…”

Section: Discussionmentioning

confidence: 99%

Catheter ablation of left‐sided accessory pathways in small children

Fogelman

Birk

Dagan

et al. 2019

Journal of Arrhythmia

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Background Accessory pathways (APs) are a common reason for supraventricular tachycardia in small children. Trans‐septal puncture (TSP) approach is commonly used for the ablation of left‐sided APs, however it may be challenging in small children. The aim of this study was to assess the efficacy and safety of trans‐septal approach radiofrequency (RF) ablation of left‐sided APs in children weighing up to 30 kg. Methods Of the 658 children who underwent catheter ablation of APs since 06/2002, 86 children had left‐sided AP and weighed less than 30 kg. TSP approach guided with TEE and fluoroscopy was used for left atrium access. Results The mean age, height, and body weight were 7.6 ± 1.9 years, 122.4 ± 9.3 cm and 24.0 ± 4.2 kg, respectively. Forty‐three children (50%) were male, 46 of 86 (53%) had manifest AP, 17 of 86 (20%) weighed less than 20 kg and in 24 of 86 children (28%) a three‐dimensional system (3DS) was used to reduce fluoroscopy time. The acute success rate was 98.8% (85/86), with a recurrence rate of 2.4% (2/85) in a mean follow‐up of 66.2 ± 42.7 (9.1‐184.2) months. The mean procedure time and fluoroscopy time were significantly lower for the 3DS group compared to the standard fluoroscopy group 131 ± 41 (55‐262) and 2.4 ± 1.5 (1‐6) minutes vs 164 ± 51 (62‐249) and 27 ± 13 (8‐77) minutes, P < 0.01 and P < 0.0001, respectively. There were no ablation‐related complications. Conclusions RF ablation of left‐sided APs using TSP approach in small children had an excellent efficacy and safety profile. The use of 3DS significantly reduces the procedure and fluoroscopy time.

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“…While TS puncture is performed routinely without fluoroscopy using ICE or TEE guidance in adults, fluoroless TS puncture in the pediatric population is more rare. Some centers even continue to utilize the retrograde approach for the ablation of left‐sided pathways . There are limited reports of TS puncture in pediatric patients with ICE guidance with acute success without complications.…”

Section: Discussionmentioning

confidence: 99%