Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy

Abstract

Background: Limited fluoroscopy cryo-ablation using a 3D electro-anatomical system (3DS) has been used for AVNRT in children. We aimed to facilitate a fluoroscopy limited approach of RF ablation of AVNRT in children.

Methods: A retrospective study was performed of procedure parameters in children undergoing RF ablation of AVNRT in 75 consecutive children (June 2011 to November 2013 - Group A) using standard fluoroscopy techniques compared to those of 64 consecutive children (December 2013 to May 2015 - Group B), using a fluoroscopy limited approach with 3DS.

Results: The acute success rate was 98.7% (74/75) and 98.4% (63/64) for groups A and B, respectively. The recurrence rate was 2.7% (2/74) and 0% (0/63) with a mean follow-up period of 45.5±12.1 and 14.3±6.1months for group A and group B, respectively. The mean procedure and fluoroscopy times were significantly lower for group B compared to group A (119±37 (43-203) and 0.83±1.04 (0.05-3.83) minutes versus 146±53 (72-250) and 16.1±8.9 (4.39-55) minutes, p<0.003 and p<0.0001, respectively). There were no ablation-related complications.

Conclusions: A fluoroscopy limited approach for RF ablation of AVNRT in children using a 3DS is easily acquired and adapted, and significantly reduces the fluoroscopy and procedure time with excellent efficacy, safety and low recurrence rate.

Condensed abstract: This study confirmed that a 3D mapping system (3DS) to guide ablations of AVNRT in children reduces radiation exposure. Combined, limited fluoroscopy and 3DS in a methodology that resembles the familiar conventional fluoroscopy approach for RF ablation of AVNRT in children is proposed. Combined limited fluoroscopy and RF-energy in children with AVNRT are associated with a shorter procedure time, minimal fluoroscopy time, a high success rate and a low recurrence rate.

Keywords: Atrioventricular nodal reentrant tachycardia (AVNRT); Catheter ablation; Electro-anatomic mapping systems; Limited fluoroscopy.