Ablation of supraventricular tachycardia in children using a limited fluoroscopy approach with the electro-anatomical system guidance

Abstract

Aim: Athough, catheter ablation has become established therapy for treatment of pediatric SVT, X-ray has been used during electrophysiological procedures. Recent advances in electroanatomic mapping technologies resulted in a decrease or elimination of fluoroscopy during catheter ablation. Although, radiofrequency ablation (RFA) is a common option for treatment of tachyarrhythmias, it has irreversible risk of AV block. Cryoablation is preferred for septal tachycardia substrates due its safety. In this study, we presented our results of children who underwent SVT ablation using electroanatomical system and experiences in cryoablation. Method: A total of 48 children underwent ablation of SVT. All procedures were performed using the EnSite System (St. Jude Medical, Inc., St. Paul, MN, USA). Results: Thirty patients had AVNRT, one of these had an additional atrial tachycardia and the other one had atypical AVRNT, 7 had concealed AP, 9 had manifest AP, 2 had atrial tachycardia, and one had Mahaim AP. Fluoroscopy was not used in 42 patients (87.5%). The mean fluoroscopy time in the remaining 6 (12.5%) patients was 6.0±2.28 minutes.Cryoab-lation was used in 34 (70.8%) and RFA in 14 (29.2%). Acute success was 9A5.8%. During follow-up of duration, SVT recurred in 3 patients (6.2%). These patients underwent second successful ablation procedures. Final success was 100 %. No permanent AV block was observed. An uneventful pericardial needle injury occured in one patient during transseptal puncture with minimal effusion. Conclusions: Catheter ablation of SVT can be performed effectively with limited fluoroscopy approach. Cryoablation should be preferred for ablation of septal tachycardia substrates, including AVNRT. © 2018, Logos Medical Publishing. All rights reserved.