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. 2023 Sep 6;10(9):1513.
doi: 10.3390/children10091513.

Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

Mirko Topalović  1 , Matevž Jan  2 , Tine Prolič Kalinšek  2 , David Žižek  3 , Jernej Štublar  2 , Rina Rus  1 , Dimitrij Kuhelj  4
Affiliations

Zero-Fluoroscopy Catheter Ablation of Supraventricular Tachycardias in the Pediatric Population

Mirko Topalović et al. Children (Basel). .

Abstract

Catheter ablation (CA) of supraventricular tachycardias (SVTs) is conventionally performed with the aid of X-ray fluoroscopy. Usage of a three-dimensional (3D) electro-anatomical mapping (EAM) system and intracardiac echocardiography (ICE) enables zero-fluoroscopy ablation, eliminating the harmful effects of radiation. We retrospectively analyzed the feasibility, effectiveness and safety of zero-fluoroscopy radiofrequency and cryoablation of various types of SVTs in pediatric patients. Overall, in 171 consecutive patients (12.5 ± 3.9 years), 175 SVTs were diagnosed and 201 procedures were performed. The procedural success rate was 98% (193/197), or more precisely, 100% (86/86) for AVNRT, 95.8% (91/95) for AVRT, 94.1% (16/17) for AT and 100% (2/2) for AFL. No complications were recorded. Follow-up was complete in 100% (171/171) of patients. During the mean follow-up period of 488.4 ± 409.5 days, 98.2% of patients were arrhythmia-free with long-term success rates of 98.7% (78/79), 97.5% (78/80), 100% (13/13) and 100% (2/2) for AVNRT, AVRT, AT and AFL, respectively. Zero-fluoroscopy CA of various types of SVTs in the pediatric population is a feasible, effective and safe treatment option.

Keywords: catheter ablation; children; supraventricular tachycardia; zero-fluoroscopy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A partial 3D reconstruction of the right atrial anatomy relevant for AVNRT ablation. (A) Right anterior oblique view. (B) Left lateral view. Yellow dots mark the His location, and green dots mark the location of cryo mapping at the presumed slow pathway location. Blue dots mark CRA lesions at the initially successful cryo mapping sites. CS, coronary sinus.
Figure 2
Figure 2
A partial 3D reconstruction of the anatomy relevant for left AP ablation with the mitral annular region activation map during preexcitation: (A) modified inferior view; (B) left anterior oblique view. Yellow dots mark His position. Red dots mark the RFA ablation lesions on the mitral annulus at the site of the earliest ventricular intracardiac signal.
Figure 3
Figure 3
Right atrial 3D reconstruction with an activation map obtained during atrial tachycardia. (A) Right to left view. (B) Right anterior oblique view. Yellow dot marks the His location. Red dots mark the ablation lesions at the distal crista terminalis, which was the site of the earliest atrial activation during atrial tachycardia.
See this image and copyright information in PMC

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