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Dos Santos Sousa IB, Chokr MO, Melo SL, Pisani CF, Hardy CA, de Moura LG, Sacilotto L, Wu TC, Darrieux FCC, Scanavacca MI. Comparison between cryotherapy and radiofrequency energy sources for parahisian accessory pathway percutaneous ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01841-8. [PMID: 38833098 DOI: 10.1007/s10840-024-01841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Catheter ablation of parahisian accessory pathways (PHAP) are challenging due to their proximity to the normal conduction system. Retrospective studies suggest that cryoablation has a better safety profile but a higher recurrence rate when compared to radiofrequency ablation (RFCA). The objective of this study was to compare the results of parahisian AP ablation performed by electrophysiologists with experience in both technologies. METHODS Prospective single-center, non-blinded and 1:1 model was used. Patients included had parahisian AP confirmed by an electrophysiological study and referred for radiofrequency or cryotherapy ablation according to current guidelines, under fluoroscopic guidance. No electroanatomic mapping was used. RESULTS A total of 30 patients (mean age of 25±9.4 years; 90% male) were enrolled between Oct/2018 to Feb/2020. Acute success rate between RFCA and CRYO were similar (93% vs. 87%, p = 0.54). A nonsignificant reduction in short-term recurrence rate for RFCA (14% vs. 30%, p = 0.3) and mechanical trauma (6% vs. 20%; p = 0.28) was observed. Long-term recurrence rate and event-free survival time were similar in both groups after 1-year follow-up (p = 0.286). No persistent complete AV block or conduction disturbance was also observed. CONCLUSION Considering the limitation of a small sample size and the lack of use of electroanatomic mapping for RFCA, the efficacy and safety profile of parahisian AP ablation with RFCA was not different from CRYO, when performed by experienced electrophysiologists. No cases of permanent complete AV block were reported with either energy modalities.
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Affiliation(s)
- Italo Bruno Dos Santos Sousa
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil.
| | - Muhieddine Omar Chokr
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Sissy Lara Melo
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Cristiano Faria Pisani
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Carina Abigail Hardy
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Lucas Goyanna de Moura
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Luciana Sacilotto
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Tan Chen Wu
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | | | - Mauricio Ibrahim Scanavacca
- Cardiac Arrhythmia Unit, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
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Paul T, Krause U, Sanatani S, Etheridge SP. Advancing the science of management of arrhythmic disease in children and adult congenital heart disease patients within the last 25 years. Europace 2023; 25:euad155. [PMID: 37622573 PMCID: PMC10450816 DOI: 10.1093/europace/euad155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/26/2023] Open
Abstract
This review article reflects how publications in EP Europace have contributed to advancing the science of management of arrhythmic disease in children and adult patients with congenital heart disease within the last 25 years. A special focus is directed to congenital atrioventricular (AV) block, the use of pacemakers, cardiac resynchronization therapy devices, and implantable cardioverter defibrillators in the young with and without congenital heart disease, Wolff-Parkinson-White syndrome, mapping and ablation technology, and understanding of cardiac genomics to untangle arrhythmic sudden death in the young.
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Affiliation(s)
- Thomas Paul
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology, Intensive Care Medicine and Neonatology, Pediatric Heart Center, Georg-August-University Medical Center, Robert-Koch-Str, 40, Göttingen D-37075, Germany
| | - Shubhayan Sanatani
- Children’s Heart Centre, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Susan P Etheridge
- Pediatric Cardiology, University of Utah School of Medicine and Primary Children’s Medical Center, Salt Lake City, UT
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Christmyer Z, Pisupati M, Shah MJ, Srinivasan C, Vetter VL, Iyer VR, Triguba M, Janson CM. Risk Stratification in Pediatric Wolff-Parkinson-White: Practice Variation Among Pediatric Cardiologists and Electrophysiologists. Pediatr Cardiol 2023:10.1007/s00246-023-03247-1. [PMID: 37544951 DOI: 10.1007/s00246-023-03247-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Published guidelines provide recommendations for risk stratification in pediatric Wolff-Parkinson-White (WPW). There are no data on provider concordance with these guidelines. We hypothesized that significant practice variation exists between pediatric cardiologists (PC) and electrophysiologists (EP). METHOD The records of all patients, age 8 to 21 years, with a new ECG diagnosis of WPW between 1/1/2013 and 12/31/2018, from a single center, were retrospectively reviewed. Subjects were categorized on the basis of symptoms and resting ECG findings as one of the following: asymptomatic intermittent WPW, asymptomatic persistent WPW, or symptomatic WPW. The performance and results of diagnostic testing, including Holter monitor, event monitor, exercise stress test (EST), and electrophysiology study (EPS), were recorded. The primary outcome was concordance with published guidelines. A secondary outcome was documentation of a discussion of sudden cardiac death (SCD) risk. RESULTS 615 patient encounters were analyzed in 231 patients with newly diagnosed WPW pattern on ECG (56% male; mean age at diagnosis 13.9 ± 2.5 years). EP were observed to have a significantly higher rate of guideline concordance than PC (95% vs. 71%, p < 0.001). There was significant practice variation between PC and EP in the documentation of a discussion of SCD risk: 96% in EP vs. 39% in PC (p < 0.001). CONCLUSION Significant practice variation exists in the non-invasive and invasive risk stratification of pediatric WPW, with lower concordance to published guidelines amongst PC, when compared to EP. This report highlights the need to promote awareness of current WPW guidelines in the pediatric cardiology community at large.
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Affiliation(s)
- Zane Christmyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Meghana Pisupati
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Maully J Shah
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Chandra Srinivasan
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Victoria L Vetter
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - V Ramesh Iyer
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Mary Triguba
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher M Janson
- Division of Cardiology, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Rossillo A, Borio G, Vittadello S, Spadaro GL, Bonanno C, Raviele A, Caprioglio F. Focal atrial tachycardia arising from left superior pulmonary vein in a pediatric patient, safely treated by pulsed-field ablation. J Cardiovasc Electrophysiol 2023; 34:1764-1767. [PMID: 37354446 DOI: 10.1111/jce.15980] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION We describe the first case of the use of pulsed-field ablation (PFA) to treat focal atrial tachycardia (FAT) in a pediatric patient. METHODS An 11-year-old girl with obesity was referred to our center for ablation of incessant atrial tachycardia. The earliest atrial activation was shown to be present in the left superior pulmonary vein. Radiofrequency ablation of FAT seems to be associated with a lower success rate and, especially, with a higher complication rate than in adult patients. RESULTS We performed ablation by means of a novel nonthermal energy source (PFA) that is able to reduce the risk of complications due to injury to anatomic structures surrounding the heart. After the first application, stable sinus rhythm was restored. CONCLUSIONS PFA can be used to treat FAT arising from pulmonary veins in young children as a good alternative to RFA ablation, thereby reducing the risk of potential procedure-related complications.
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Affiliation(s)
| | - Gianluca Borio
- Department of Cardiology, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Carlo Bonanno
- Department of Cardiology, San Bortolo Hospital, Vicenza, Italy
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Meziab O, Dionne A, Przybylski R, Triedman JK, Walsh EP, Mah DY. Clinical implications of a unique delta wave pattern in patients with left-sided Wolff-Parkinson-White. Europace 2023; 25:euad104. [PMID: 37070604 PMCID: PMC10228622 DOI: 10.1093/europace/euad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Omar Meziab
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert Przybylski
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - John K Triedman
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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6
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Berul CI. Viewpoint: New Frontiers in Taking Care of Children with Heart Rhythm Disorders and Pediatric Electrophysiology Publications. Heart Rhythm 2023; 20:935-936. [PMID: 36933852 DOI: 10.1016/j.hrthm.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/20/2023]
Affiliation(s)
- Charles I Berul
- Children's National Hospital, George Washington University School of Medicine, Washington, DC.
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7
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Janson CM, Shah MJ, Kennedy KF, Iyer VR, Behere S, Sweeten TL, O'Byrne ML. Association of Weight With Ablation Outcomes in Pediatric Wolff-Parkinson-White: Analysis of the NCDR IMPACT Registry. JACC Clin Electrophysiol 2023; 9:73-84. [PMID: 36697203 DOI: 10.1016/j.jacep.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Guidelines for electrophysiology study (EPS) and catheter ablation in Wolff-Parkinson-White (WPW) are age based, but size may be a more relevant factor in determination of outcomes. OBJECTIVES The goal of this study was to evaluate the association of patient weight with outcomes of catheter ablation for pediatric WPW. METHODS A multicenter retrospective cohort study was performed on children aged 1 to 21 years with WPW and first-time EPS from April 2016 to December 2019 recorded in the IMPACT (Improving Pediatric and Adult Congenital Treatment) registry, excluding those with congenital heart disease, cardiomyopathy, and >1 ablation target. A weight threshold of 30 kg was selected, representing 1 SD below the cohort mean. The primary outcome was major adverse events (MAEs); additional outcomes included deferred ablation, use of cryoablation, and ablation success. RESULTS A total of 4,456 subjects from 84 centers were evaluated, with 14% weighing <30 kg. Subjects weighing <30 kg were more likely to have preprocedural supraventricular tachycardia (45% vs 29%; P < 0.001) and less likely to have right septal accessory pathways (25% vs 33%; P < 0.001). MAEs were rare, although with higher incidence in the <30 kg cohort (0.3% vs 0.05%; P = 0.04). No difference was seen in likelihood of deferred ablation (9% vs 12%; P = 0.07) or use of cryoablation (11% vs 11%; P = 0.70). Success was higher in the <30 kg cohort: 95% vs 92% (P = 0.009). This effect persisted after adjusting for covariates (odds ratio: 1.6; 95% CI: 1.01-2.70; P = 0.046). CONCLUSIONS Weight <30 kg was associated with a small but elevated risk of MAEs. Rates of deferred ablation and cryoablation were similar. Adjusting for factors (including accessory pathway type and location), weight <30 kg remained an independent predictor of acute success.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Maully J Shah
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kevin F Kennedy
- Mid America Heart Institute and St. Luke's Health System, Kansas City, Missouri, USA
| | - V Ramesh Iyer
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shashank Behere
- Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Tammy L Sweeten
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael L O'Byrne
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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8
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Sun Y, Xiao X, Yin X, Gao L, Yu X, Zhang R, Wang Z, Dai S, Yang Y, Xia Y. Impact of baseline impedance of pulmonary vein antrum on success of catheter ablation for paroxysmal atrial fibrillation guided by ablation index. BMC Cardiovasc Disord 2022; 22:179. [PMID: 35439961 PMCID: PMC9016960 DOI: 10.1186/s12872-022-02530-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Ablation index (AI) is an effective ablation quality marker. Impedance is also an important factor for lesion formation. The present study evaluated the influence of the baseline impedance in the effect of ablation for atrial fibrillation (AF) guided by AI. Methods This was a retrospective study. 101 patients with paroxysmal AF (PAF) were enrolled. All patients underwent radiofrequency ablation guided by the same AI strategy. The ablation strategy was pulmonary vein (PV) isolation with non-PV triggers ablation. The baseline impedance of the ablation points was recorded. The patients were followed up every 3 months or so. Results During a median follow-up of 12 (4–14) months, freedom from AF/atrial tachycardia recurrence were 82.2%. No difference existed in baseline characteristics between the success group and the recurrence group. The average baseline impedance was 124.3 ± 9.7 Ω. The baseline impedance of the ablation points in success group was lower compared to the recurrence group (122.9 ± 9.4 vs. 130.5 ± 8.8 Ω, P < 0.01). The ratio of impedance drop in the success group was higher than the recurrence group ([8.8 ± 1.4]% vs. [8.1 ± 1.2]%, P = 0.03). Multivariate analysis revealed that baseline impedance, PAF duration and AI were the independent predictors of AF recurrence. The cumulative free of recurrence rate of low-impedance group (≤ 124 Ω, n = 54) was higher than that of high-impedance group. Conclusion Baseline impedance correlates with clinical outcome of radiofrequency ablation for PAF guided by AI. Higher impedance in the same AI strategy may result in an ineffective lesion which probably causes recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02530-y.
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Affiliation(s)
- Yuanjun Sun
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Xianjie Xiao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Xiaomeng Yin
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China.
| | - Lianjun Gao
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Xiaohong Yu
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Rongfeng Zhang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Zhongzhen Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Shiyu Dai
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Yanzong Yang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China
| | - Yunlong Xia
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Rd, Dalian, 116011, Liaoning, China.
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Corcia MCG, Stuart G, Walsh M, Radulescu C, Spera F, Tijskens M, Heidbuchel H, Sarkozy A. Redo accessory pathway ablation in the pediatric population. J Interv Card Electrophysiol 2022; 63:639-649. [PMID: 34811627 PMCID: PMC9151527 DOI: 10.1007/s10840-021-01064-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/07/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Literature reports 5% of recurrence/failure in paediatric accessory pathway ablations. Our aim was to investigate the reasons underlying this finding and share techniques to obtain long-term success. METHODS Thirty-nine paediatric patients referred for a repeat procedure were analysed: characteristics of the pathways and the initial and redo procedures were identified. RESULTS Mean age was 11.9 ± 3.3 years (59% males). Three patients (8%) had multiple accessory pathways. The most frequent location was left lateral (26%). Left sided pathway recurrence was caused mainly by poor contact (60%) and inadequate mapping (40%). For right lateral accessory pathways, poor contact accounted for 70% of failures. For antero-septal and para-Hisian locations, the use of cryoablation and choice of low radiofrequency energy delivery accounted for > 75% of failures. Long-term success strategies included choice of contact force catheters and radiofrequency applications at the ventricular insertion of the pathway and in the aortic coronary cusps. In postero-septal substrates, the main reason accounting for failure was deep or epicardial location of the pathway (37%), solved by using an irrigated tip catheter or applying lesions within the coronary sinus, or applications from both right and left postero-septal areas. CONCLUSION Acute failure and post-procedure recurrence in paediatric accessory pathway ablations have multiple reasons related to the characteristics of the pathway and the technology available. Accurate understanding of the anatomy, careful mapping and pacing manoeuvers, and incorporation of new technologies contribute to achieve a definitive success in > 98% of procedures.
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Affiliation(s)
- M Cecilia Gonzalez Corcia
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium.
| | - Graham Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Mark Walsh
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Cristina Radulescu
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Francesco Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Maxime Tijskens
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
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Walsh EP, Law IH, Van Hare GF. The Evolution of Pediatric and Congenital Electrophysiology as a Subspecialty. Pediatr Cardiol 2022; 43:776-783. [PMID: 34853879 DOI: 10.1007/s00246-021-02785-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022]
Abstract
Over the past 50 years, pediatric and congenital electrophysiology has progressed from a rare subspecialty practiced at just a handful of centers to become an essential part of nearly every congenital heart program the world over. This paper traces the evolution of the subspecialty in North America by recognizing the individuals who dedicated their careers to this field and trained subsequent generations of practitioners, thereby establishing a legacy that insures continued progress in the treatment of arrhythmias for children and patients with congenital heart disease. Data were generated from a survey of the current membership of the Pediatric and Congenital Electrophysiology Society and were supplemented by review of archived Society records. Maps depicting the locations for clinicians and training centers over time provide a graphic display of progress in this field.
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Affiliation(s)
- Edward P Walsh
- Harvard Medical School, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Ian H Law
- Stead Family Children's Hospital, University of Iowa Carver College of Medicine, Iowa City, USA
| | - George F Van Hare
- Saint Louis Children's Hospital, Washington University School of Medicine, Saint Louis, USA
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11
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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12
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Ramos-Maqueda J, Álvarez M, Cabrera-Ramos M, Perin F, Rodríguez-Vázquez Del Rey MDM, Jiménez-Jaimez J, Macías-Ruiz R, Molina-Lerma M, Sánchez-Millán P, Tercedor-Sánchez L. Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:166-173. [PMID: 33741288 DOI: 10.1016/j.rec.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. METHODS We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). RESULTS We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). CONCLUSIONS The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.
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Affiliation(s)
- Javier Ramos-Maqueda
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Miguel Álvarez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Mercedes Cabrera-Ramos
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Francesca Perin
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Servicio de Pediatría, Hospital Materno Infantil Virgen de las Nieves, Granada, Spain
| | | | - Juan Jiménez-Jaimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rosa Macías-Ruiz
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Manuel Molina-Lerma
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Sánchez-Millán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Luis Tercedor-Sánchez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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13
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Ramos-Maqueda J, Álvarez M, Cabrera-Ramos M, Perin F, Rodríguez-Vázquez del Rey MDM, Jiménez-Jaimez J, Macías-Ruiz R, Molina-Lerma M, Sánchez-Millán P, Tercedor-Sánchez L. Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Krause U, Paul T, Bella PD, Gulletta S, Gebauer RA, Paech C, Kubus P, Janousek J, Ferrari P, De Filippo P. Pediatric catheter ablation at the beginning of the 21st century: results from the European Multicenter Pediatric Catheter Ablation Registry 'EUROPA'. Europace 2021; 23:431-440. [PMID: 33227133 DOI: 10.1093/europace/euaa325] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Contemporary data from prospective multicentre registries on catheter ablation in pediatric patients are sparse. Aim of the European Pediatric Catheter Ablation Registry EUROPA was to contribute data to fill this gap of knowledge. METHODS AND RESULTS From July 2012 to June 2017, data on catheter ablation in pediatric patients (≤18 years of age) including a 1-year follow-up from five European pediatric EP centres were collected prospectively. A total of 683 patients (mean age 12.4 ± 3.9 years, mean body weight 50.2 ± 19 kg) were enrolled. Target tachycardia was WPW/atrioventricular-nodal re-entrant tachycardia (AVRT) in 380 (55.7%) patients, AVNRT in 230 (33.8%) patients, ventricular tachycardia (VT) in 24 (3.5) patients, focal atrial tachycardia (FAT) in 20 (2.9%) patients, IART in 14 (2%) patients, and junctional ectopic tachycardia in 3 (0.45) patients. Overall procedural success was 95.6%. Compared with all other substrates, success was significantly lower in FAT patients (80%, n = 16, P = 0.001). Mean procedure duration was 136 ± 67 min and mean fluoroscopy time was 4.9 ± 6.8 min. Major complications occurred in 0.7% of the patients. No persisting AV block requiring permanent pacing was reported. At 1-year follow-up (605/683 patients, 95%), tachycardia recurrence was reported in 7.8% of patients. Recurrence after VT ablation (33%) was significantly higher (P = 0.001) than after ablation of all other substrates. CONCLUSION The present study proves overall high efficacy and safety of catheter ablation of various tachycardia substrates in pediatric patients. Of note, complication rate was exceptionally low. Long-term success was high except for patients after VT ablation.
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Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University, Göttingen 37099, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University, Göttingen 37099, Germany
| | | | - Simone Gulletta
- Arrhyhtmia Department, Ospedale San Raffaele, Milano, 20132, Italy
| | - Roman A Gebauer
- Pediatric Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Christian Paech
- Pediatric Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Peter Kubus
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, 15006, Czech Republic
| | - Jan Janousek
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, 15006, Czech Republic
| | - Paola Ferrari
- Unita di Elettrofisiologia ed Elettrostimolazione Cardiaca, Ospedale Papa Giovanni XXIII, Bergamo, 24127, Italy
| | - Paolo De Filippo
- Unita di Elettrofisiologia ed Elettrostimolazione Cardiaca, Ospedale Papa Giovanni XXIII, Bergamo, 24127, Italy
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15
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Van Hare GF. Radiofrequency ablation in the young. Heart Rhythm 2021; 18:1454-1455. [PMID: 34334158 DOI: 10.1016/j.hrthm.2021.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- George F Van Hare
- Pediatric Cardiology Division, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri.
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16
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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17
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Young C, Kwan A, Yepez L, McCarty M, Chan A, Hsu D, Han J, Taneja T, Park S, Hayward R, Liu TI. Contemporary procedure characteristics and outcomes of accessory atrioventricular pathway ablations in an integrated community-based health care system using a tiered approach. BMC Cardiovasc Disord 2021; 21:319. [PMID: 34193076 PMCID: PMC8243587 DOI: 10.1186/s12872-021-02132-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background Since the early descriptions of large series of accessory atrioventricular pathway ablations in adults and adolescents over 20 years ago, there have been limited published reports based on more recent experiences of large referral centers. We aimed to characterize accessory pathway distribution and features in a large community-based population that influence ablation outcomes using a tiered approach to ablation. Methods Retrospective analysis of 289 patients (age 14–81) who underwent accessory ablation from 2015–2019 was performed. Pathways were categorized into anteroseptal, left freewall, posteroseptal, and right freewall locations. We analyzed patient and pathway features to identify factors associated with prolonged procedure time parameters. Results Initial ablation success rate was 94.7% with long-term success rate of 93.4% and median follow-up of 931 days. Accessory pathways were in left freewall (61.6%), posteroseptal (24.6%), right freewall (9.6%), and anteroseptal (4.3%) locations. Procedure outcome was dependent on pathway location. Acute success was highest for left freewall pathways (97.1%) with lowest case times (144 ± 68 min) and fluoroscopy times (15 ± 19 min). Longest procedure time parameters were seen with anteroseptal, left anterolateral, epicardial-coronary sinus, and right anterolateral pathway ablations. Conclusions In this community-based adult and adolescent population, majority of the accessory pathways are in the left freewall and posteroseptal region and tend to be more easily ablated. A tiered approach with initial use of standard ablation equipment before the deployment of more advance tools, such as irrigated tips and 3D mapping, is cost effective without sacrificing overall efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02132-0.
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Affiliation(s)
- Charlie Young
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Annie Kwan
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Lisa Yepez
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Meghan McCarty
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Amanda Chan
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Dora Hsu
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Jennifer Han
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Taresh Taneja
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Shirley Park
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Robert Hayward
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA
| | - Taylor I Liu
- Department of Cardiac Electrophysiology, Kaiser Permanente NCAL, Kaiser Santa Clara Medical Center, 710 Lawrence Expressway, Department 342, Santa Clara, CA, 95051, USA.
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18
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Walsh MA, Gonzalez CM, Uzun OJ, McMahon CJ, Sadagopan SN, Yue AM, Seller N, Hares DL, Bhole V, Till J, Wong L, Mangat JS, Lowe MD, Rosenthal E, Bowes M, Stuart AG. Outcomes From Pediatric Ablation: A Review of 20 Years of National Data. JACC Clin Electrophysiol 2021; 7:1358-1365. [PMID: 34217658 DOI: 10.1016/j.jacep.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study set out to examine outcomes from pediatric supraventricular tachycardia ablations over a 20-year period. This study sought to examine success rates and repeat ablations over time and to evaluate whether modalities such as 3-dimensional (3D) mapping, contact force, and cryotherapy have improved outcomes. BACKGROUND Ablation of supraventricular tachycardia in pediatric patients is commonly performed in most congenital heart centers with excellent long-term results. METHODS Data were retrieved from the NICOR (National Institute of Clinical Outcomes Research) database in the United Kingdom. Outcomes over time were evaluated, and procedure-related details were compared. RESULTS There were 7,069 ablations performed from January 1, 1999, to December 31, 2018, at 10 centers. Overall, ablation success rates were 92% for accessory pathways, 97% for atrioventricular node re-entry tachycardia, and 89% for atrial tachycardia. There was an improvement in procedural success rates over time (p < 0.01). The use of 3D mapping did not alter success or need for repeat ablation but was associated with a higher proportion of lower fluoroscopy cases; 55% of 3D mapping cases used < 5 min of fluoroscopy (p < 0.01). Patients needing a repeat ablation were 341 (12%) for accessory pathways, 128 (7%) for atrioventricular node re-entry tachycardia, and 35 (7%) for atrial tachycardia. Overall, the risk of complete heart block was low (12 patients, <0.01%). The use of cryotherapy was associated with an increased risk of needing a repeat ablation. CONCLUSIONS Overall success rates from pediatric ablations are excellent and compare favorably to other registries. Introduction of newer technologies have likely made procedures safer and reduced radiation exposure, but they have not changed success rates or the need for a repeat procedure.
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Affiliation(s)
- Mark A Walsh
- Department of Pediatric Cardiology, Children's Health Ireland, Crumlin, Dublin, Ireland.
| | - Cecilia M Gonzalez
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol Heart Institute, University Hospital Bristol, Bristol, United Kingdom
| | - Orhan J Uzun
- Department of Pediatric Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Colin J McMahon
- Department of Pediatric Cardiology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Shankar N Sadagopan
- Department of Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Arthur M Yue
- Department of Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Neil Seller
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Dominic L Hares
- Department of Cardiology, The Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
| | - Vinay Bhole
- Pediatric Cardiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Jan Till
- Department of Congenital Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Leonie Wong
- Department of Congenital Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Jasveer S Mangat
- Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Martin D Lowe
- Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Eric Rosenthal
- Department of Pediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Michael Bowes
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Alan G Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol Heart Institute, University Hospital Bristol, Bristol, United Kingdom
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19
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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20
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Clinical Approach to Symptomatic and Asymptomatic Patients with Ventricular Pre-excitation. Card Electrophysiol Clin 2020; 12:527-539. [PMID: 33162001 DOI: 10.1016/j.ccep.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite extensive knowledge of the physiopathology of ventricular pre-excitation, management of asymptomatic patients with this condition remains controversial.
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21
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Drago F, Tamborrino PP, Cazzoli I. Ablation in Pediatric Patients and in Association with Congenital Heart Disease. Card Electrophysiol Clin 2020; 12:583-590. [PMID: 33162005 DOI: 10.1016/j.ccep.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transcatheter ablation (TA) for treatment of pediatric tachyarrhythmias was first introduced in the early 1990s. Since then, its use as an alternative to antiarrhythmic drugs to treat supraventricular tachycardias caused by accessory pathway has been increasing. Nowadays, TA can be performed with high success rates and low complication rates even in very young children. Recently, the use of different types of energy (radiofrequency and cryoenergy), special ablation catheters, and 3D nonfluoroscopic mapping systems equipped with high technological tools has further improved safety and efficacy of TA, especially in difficult substrates and in patients with congenital heart disease.
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Affiliation(s)
- Fabrizio Drago
- Cardiology and Electrophysiology/Syncope Unit, Cardiology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Pietro Paolo Tamborrino
- Cardiology and Electrophysiology/Syncope Unit, Cardiology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ilaria Cazzoli
- Cardiology and Electrophysiology/Syncope Unit, Cardiology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Dionne A, Gauvreau K, O'Leary E, Mah DY, Abrams DJ, Alexander ME, DeWitt ES, Bezzerides VJ, Triedman JK, Walsh EP. Risk Factors for Early Recurrence Following Ablation for Accessory Pathways: The Role of Consolidation Lesions. Circ Arrhythm Electrophysiol 2020; 13:e008848. [PMID: 33017181 DOI: 10.1161/circep.120.008848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrioventricular reentrant tachycardia is common in children. Catheter ablation is increasingly used as a first-line therapy with a high acute success rate, but recurrence during follow-up remains a concern. The aim of this study was to identify risk factors for recurrence after accessory pathway (AP) ablation. METHODS Retrospective cohort study including patients who underwent AP ablation between 2013 and 2018. Cox proportional hazards model was used to examine the association between patient and procedural characteristics and recurrence during follow-up. RESULTS From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 (interquartile range, 0.1-1.4) years, there were 42 (8%) patients with documented recurrence. On univariate analysis, early recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and posteroseptal versus left sided), cryoablation (versus radiofrequency), empirical ablation, the lack of full power radiofrequency lesions (<50 W), radiofrequency consolidation time <90 seconds and the use of fluoroscopy without a 3-dimensional electroanatomic mapping system. On multivariable analysis, only multiple AP (hazard ratio, 2.78 [95% CI, 1.063-4.74]) and radiofrequency consolidation time < 90 seconds (hazard ratio, 4.38 [95% CI, 1.92-9.51]) remained significantly associated with early recurrence; this association remained true when analyzed in subgroups by pathway location for right and left free wall AP. CONCLUSIONS In our institutional experience, radiofrequency consolidation time <90 seconds after ablation of AP was associated with an increased risk of early recurrence.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Vassilios J Bezzerides
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
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Arrhythmia in Children and Adolescents and Outcome of Radiofrequency Ablation for Tachyarrhythmias — A Single Center Experience Over 16 Years. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Kilinc OU, Zhao X, Jenkins MW, Snyder CS, Rollins AM. Imaging of Atrioventricular Nodal Conduction Tissue in Porcine Hearts Using Optical Coherence Tomography. J Innov Card Rhythm Manag 2020; 10:3675-3680. [PMID: 32477734 PMCID: PMC7252643 DOI: 10.19102/icrm.2019.100601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
Optical coherence tomography (OCT) employs near-infrared light to image the microstructure of different tissues. Clinically, it has been used to image the walls of coronary arteries. In research settings, one of the applications for OCT is visualizing endocardial and subendocardial structures. The present experiment sought to determine whether OCT can identify native conduction tissues in adult porcine hearts. During the study, the right atrial endocardial surfaces of excised adult porcine hearts were exposed. The triangle of Koch was imaged with the OCT system and the conduction tissue was identified. The area was then prepared for histologic examination with Masson's trichrome stain. The results of histologic preparations and OCT images were then compared. Ultimately, nine porcine hearts were examined using this methodology. OCT imaging successfully identified subendocardial structures presumed to be the compact atrioventricular node. Histologic images of the preparations delineated the different tissue types and conduction tissue was easily identified. The location of distinctive hyporeflective areas in the OCT images correlated with the location of conduction tissue in the histology images. In light of the findings of this study, it is suggested that atrioventricular nodal tissue can be identified by OCT in freshly dissected unfixed porcine hearts. OCT images distinguished the differentiated conduction tissue in close proximity with the endocardium, myofibers, and fibrous tissue, and the success of this was verified with histology. This technology may be useful for the direct visualization of the native conduction system during procedures in the operating room and electrophysiology laboratory. Further studies with perfused tissue samples and live animal experiments are needed to better assess the efficacy of this novel application.
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Affiliation(s)
- Orhan U Kilinc
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Xiaowei Zhao
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Michael W Jenkins
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA.,Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Christopher S Snyder
- Congenital Heart Collaborative, Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Andrew M Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Kovach JR, Mah DY, Abrams DJ, Alexander ME, Cecchin F, Triedman JK, Walsh EP. Outcomes of catheter ablation of anteroseptal and midseptal accessory pathways in pediatric patients. Heart Rhythm 2020; 17:759-767. [DOI: 10.1016/j.hrthm.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Indexed: 10/25/2022]
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26
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Kato Y, Suzuki T, Yoshida Y, Ozaki N, Kishimoto S, Aoki H, Yoshida S, Watanabe S, Nakamura Y. Catheter ablation in children and patients with congenital heart disease: Review of 1021 procedures at a high-volume single center in Japan. Heart Rhythm 2020; 17:49-55. [DOI: 10.1016/j.hrthm.2019.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Indexed: 11/26/2022]
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"If at first you don't succeed": repeat ablations in young patients with supraventricular tachycardia. J Interv Card Electrophysiol 2019; 59:423-429. [PMID: 31834569 DOI: 10.1007/s10840-019-00672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Success rates for catheter ablation of supraventricular tachycardia (SVT) in the young exceed 90%. While studies have described reasons for initial ablation failure, less is known about outcomes of repeat ablation attempts. The purpose of this study was to report acute and mid-term success rates for second ablation attempts in young patients, as well as to analyze factors that may affect these outcomes. METHODS Retrospective single-center study of all patients undergoing a second ablation attempt for WPW (Wolff-Parkinson-White) or SVT from 2008 to 2017. Inclusion criteria are all patients < 21 years old at the time of their first ablation who underwent a second ablation attempt. An intention to treat analysis was performed. RESULTS Fifty-five patients met inclusion criteria, with a median age of 15 years (IQR 12-16). The most common arrhythmia mechanisms at repeat procedure were single accessory pathways (n = 32, 58%) and AVNRT (n = 14, 25%). Six patients (11%) were found to have a different SVT mechanism than at initial ablation. Acute success at repeat ablation was achieved in 48 patients (87%). At mid-term follow-up (10.5 months, IQR 0.6-25), four patients (8% of acute successes) experienced SVT recurrence. The overall success rate of repeat ablations, accounting for acute and mid-term failures, was 80%. CONCLUSIONS In this report of 55 young patients who underwent repeat ablation for WPW and/or SVT, acute and mid-term success rates were 87% and 80%, respectively. These data may help inform decision-making when caring for patients with persistent or recurrent SVT after an initial ablation attempt.
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Backhoff D, Klehs S, Müller MJ, Schneider HE, Dieks JK, Paul T, Krause U. Long-Term Follow-Up After Radiofrequency Catheter Ablation of Accessory Atrioventricular Pathways in Children. JACC Clin Electrophysiol 2019; 4:448-455. [PMID: 30067483 DOI: 10.1016/j.jacep.2018.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate long-term safety and efficacy of catheter ablation of accessory atrioventricular pathways (AP) in a pediatric cohort. BACKGROUND Radiofrequency catheter ablation of accessory AP is the recommended treatment for patients with atrioventricular re-entrant tachycardia. Data on long-term results ≥1 year after AP ablation in pediatric patients is sparse. METHODS A total of 296 patients <18 years of age who had undergone radiofrequency-AP ablation between October 2002 and June 2015 were included into the study. Follow-up was >1 year in all patients. Median age at ablation had been 11.6 years, and median follow-up was 5.6 years. Recurrence of AP conduction after ablation was defined as documentation of pre-excitation, supraventricular tachycardia attributable to AP, or proof of AP conduction during repeat electrophysiological study. RESULTS AP ablation succeeded in 268 of 296 individuals (91%). After successful ablation, recurrence of AP conduction was observed in 29 of 268 individuals (10.8%). Of those 29, 23 (79%) had AP recurrence within the first year after ablation, whereas 13 (45%) had recurrence of AP conduction already within the first month. Six patients had late recurrence of AP conduction >1 year post-ablation. Procedural success and freedom from AP conduction after a single ablation procedure was 86% at 1 month, 83% at 1 year, and 81% at 5 years after ablation. CONCLUSIONS After radiofrequency ablation of AP in children, recurrence of AP conduction occurred in 23 subjects (8% of the study cohort) within the first year after ablation. Late recurrences >1 year after ablation were noticed in 6 children (2% of the study group), highlighting the need for longer follow-up >1 year. Results of the present study on late AP recurrence should be taken into account whenever families are counselled for pediatric AP ablation.
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Affiliation(s)
- David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany.
| | - Sophia Klehs
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Jana-Katharina Dieks
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
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Fogelman R, Birk E, Dagan T, Fogelman M, Einbinder T, Bruckheimer E, Swissa M. Catheter ablation of left-sided accessory pathways in small children. J Arrhythm 2019; 35:742-747. [PMID: 31624515 PMCID: PMC6787155 DOI: 10.1002/joa3.12219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/17/2019] [Accepted: 06/17/2019] [Indexed: 11/11/2022] Open
Abstract
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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Affiliation(s)
- Rami Fogelman
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Einat Birk
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Tamir Dagan
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Michal Fogelman
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Tom Einbinder
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Elchanan Bruckheimer
- The Schneider Children’s Medical Center of IsraelCardiology Institute, Sackler School of Medicine, Tel Aviv UniversityPetach TiqvaIsrael
| | - Moshe Swissa
- Kaplan Medical Center, The Hebrew UniversityRehovotJerusalemIsrael
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Congenital heart block: Pace earlier (Childhood) than later (Adulthood). Trends Cardiovasc Med 2019; 30:275-286. [PMID: 31262557 DOI: 10.1016/j.tcm.2019.06.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022]
Abstract
Congenital complete heart block (CCHB) occurs in 2-5% of pregnancies with positive anti-Ro/SSA and/or anti-La/SSB antibodies, and has a recurrence rate of 12-25% in a subsequent pregnancy. After trans-placental passage, these autoantibodies attack and destroy the atrioventricular (AV) node in susceptible fetuses with the highest-risk period observed between 16 and 28 weeks' gestational age. Many mothers are asymptomatic carriers, while <1/3 have a preexisting diagnosis of a rheumatic disease. The mortality of CCHB is predominant in utero and in the first months of life, reaching 15-30%. The diagnosis of CCHB can be confirmed by fetal echocardiography before birth and by electrocardiography after birth. Whether early in-utero detection and treatment might prevent or reverse this condition remains controversial. In addition to autoantibody-associated CCHB, there is also an isolated (absent structural heart disease) nonimmune early- or late-onset heart block detected later in childhood that may be associated with specific genetic markers or other pathogenic mechanisms. In isolated immune or non-immune CCHB, cardiac pacemakers are implanted in symptomatic patients, however, data on the natural history of CCHB in the adult life indicate that all patients, even if asymptomatic, should receive a pacemaker when first diagnosed. However, important issues have emerged in these patients wherein life-long conventional right ventricular apical pacing may produce left ventricular dysfunction (pacing-induced cardiomyopathy) necessitating a priori alternate site pacing or subsequent upgrading to biventricular pacing. All these issues are herein reviewed and two algorithms are proposed for diagnosis and management of CCHB in the fetus and in the older individual.
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31
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Kylat RI, Samson RA. Permanent junctional reciprocating tachycardia in infants and Children. J Arrhythm 2019; 35:494-498. [PMID: 31293698 PMCID: PMC6595346 DOI: 10.1002/joa3.12193] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/19/2019] [Indexed: 11/09/2022] Open
Abstract
Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate treatment is started early in the course, the failure can be ameliorated, and the cardiomyopathy can be resolved.
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Affiliation(s)
- Ranjit I. Kylat
- Department of PediatricsThe University of ArizonaCollege of MedicineTucsonArizona
| | - Ricardo A. Samson
- Chidren's Heart Center of NevadaLas VegasNevada
- Department of PediatricsLas Vegas School of MedicineUniversity of NevadaLas VegasNevada
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32
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Schneider HE, Stahl M, Schillinger W, Müller M, Backhoff D, Schill M, Groene N, Krause U, Sigler M, Paul T. Double cryoenergy application (freeze-thaw-freeze) at growing myocardium: Lesion volume and effects on coronary arteries late after energy application. Implications for efficacy and safety in pediatric patients. J Cardiovasc Electrophysiol 2019; 30:1127-1134. [PMID: 31111603 DOI: 10.1111/jce.13993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cryoenergy is accepted as an alternative to radiofrequency ablation (RFA) in childen for ablation of supraventricular tachycardia substrates. Single cryoenergy application has been shown to be inferior to RFA. Double cryoenergy application has therefore been introduced into clinical practice, but experience concerning efficacy is limited. Coronary artery stenosis has been reported as serious complication after RFA for arrhythmia substrates but not after single cryoablation. The purpose of the study was to assess lesion volume (efficacy) and risk of coronary artery damage (safety), late, that is, 6 months, after double cryoenergy application in a piglet model. METHODS Two sequential cycles of cryoenergy were delivered at -75°C for 4 minutes at the atrioventricular groove in five piglets. Animals were restudied after 6 months by coronary angiography and intracoronary ultrasound (ICUS). Ablation lesions were examined histologically and lesion volume was determined by three-dimensional morphometric analysis. RESULTS Cryolesion volume was 174.04 ± 67.18 mm3 for atrial and 238.69 ± 112.1 mm3 for ventricular lesions (P > .05). Ventricular lesions, 4.06 ± 1.05 mm, were significantly deeper than atrial lesions, 3.58 ± 0.78 mm, (P < .05). In two of the 29 lesions, cryoenergy induced minor coronary artery injury with mild medial and adventitial thickening as well as minimal intimal proliferation, which had neither been detected by coronary angiography nor by ICUS. CONCLUSION Late after double cryoenergy application at growing myocardium, subclinical minor affection of the coronary artery wall could be detected with minimal intimal proliferation. As lifetime sequelae of this finding remains unknown, further studies are warranted to address safety of repeated cycles of cryoenergy application for tachycardia substrates in children.
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Affiliation(s)
- Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Maja Stahl
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Wolfgang Schillinger
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | | | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Manfred Schill
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Nehle Groene
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
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Dubin AM, Cannon BC, Saarel EV, Triedman JK, Berul CI, Bar-Cohen Y, Shah MJ, Paulsen J, Patel H, Reich J, Carlson MD, Stein K, Gilkerson JO, Kowal RC, Peiris V. Pediatric and congenital electrophysiology society initiative on device needs in pediatric electrophysiology. Heart Rhythm 2019; 16:e39-e46. [DOI: 10.1016/j.hrthm.2018.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 11/16/2022]
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Gulletta S, Vergara P, Gigli L, D'Angelo G, Radinovic A, Melania Barbaro C, Trevisi N, Della Bella P. Usefulness of Electroanatomical Mapping with Contact Force Monitoring for Accessory Pathways Ablation in Pediatric Population. Pediatr Cardiol 2019; 40:713-718. [PMID: 30666358 DOI: 10.1007/s00246-019-02051-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 01/03/2019] [Indexed: 11/26/2022]
Abstract
The current approach for catheter ablation (CA) of accessory pathways (AP) includes the use of standard catheters under fluoroscopic visualization. We hypothesize that use of contact force (CF) irrigated tip catheters might increase procedural safety in pediatric patients compared to standard irrigated tip catheters, by decreasing the number of radiofrequency (RF) pulses required to obtain AP elimination. Seventy-one pediatric patients (13.7 ± 2.5 years, 45 male) with ventricular pre-excitation were enrolled in the study. CA was performed with a standard irrigated tip catheter up to June 2013 in 41 patients (Group S) and with a CF sensing irrigated tip catheter later on in 30 patients (Group CF). In the Group CF, RF was applied with a minimal CF of 5 g; CF > 35 g was avoided. Group CF procedures required less fluoroscopy (6.8 ± 4.8 min), compared to Group S (12.2 ± 10.8 min, p = 0.007). The number of RF pulses was smaller in Group CF compared to Group S (2.5 ± 2.0 vs 5.5 ± 1.9, p < 0.01). The mean CF during the effective RF pulse was 18 ± 7.7 g, force-time integral was 1040.7 ± 955.9 gs, Ablation Index was 513.0 ± 214.2. The procedure was acutely successful in 70 patients; at 12 months follow-up 2 patients had AP recurrence, one for each group. No major complications were reported. The use of CF irrigated tip catheters was associated with a smaller number of RF pulses and less fluoroscopy, as compared to mapping and ablation with standard irrigated tip catheters.
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Affiliation(s)
- Simone Gulletta
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy.
| | - Pasquale Vergara
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
| | - Lorenzo Gigli
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe D'Angelo
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Radinovic
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
| | - Carmela Melania Barbaro
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Trevisi
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Della Bella
- Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Scientific Institute, Milan, Italy
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Gartenberg AJ, Pass RH, Ceresnak S, Nappo L, Janson CM. Incidence of Echocardiographic Abnormalities Following Pediatric SVT Ablation: Comparison of Cases Utilizing Fluoroscopy Alone to Cases with Adjunctive 3D Electroanatomic Mapping. Pediatr Cardiol 2019; 40:497-503. [PMID: 30315340 DOI: 10.1007/s00246-018-1999-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
There are few data on the incidence of echocardiographic (echo) abnormalities following catheter ablation in children in the era of 3D mapping. Wide practice variation exists regarding routine post-ablation echo. We hypothesized a low incidence of clinically significant echo abnormalities following SVT ablation in otherwise healthy children. Single center data from 2009 to 2015 were reviewed; routine post-ablation echo was standard practice. Cases were categorized as utilizing fluoroscopy alone (FLUORO) or 3D mapping with a low fluoroscopic protocol (CARTO3). Congenital heart disease was excluded. Outcomes of interest included new valvular abnormalities, pericardial effusions, and wall motion abnormalities. Findings were compared to baseline studies when available and classified as normal/unchanged, clinically insignificant, or clinically significant. Outcomes were compared between FLUORO and CARTO3 groups. Of 347 ablations, 319 (92%) underwent post-procedural echo: 57% male; 55% FLUORO; mean age 13.4 ± 3.6 years. The most common ablation target was an accessory pathway (AP) in 66% (n = 144 WPW, 66 concealed), followed by AVNRT in 32% (n = 102). Radiofrequency (RF) energy was utilized in 82% (n = 262). Post-ablation echos were normal in 81% (n = 259). Clinically insignificant findings were seen in 18% (n = 58), most commonly trivial-small pericardial effusions in 11% (n = 34). Two significant findings required additional follow-up or treatment. There were no cases of wall motion abnormalities or clinically significant effusions. There were no differences in frequency of echo abnormalities between the FLUORO and CARTO3 groups. Clinically significant echocardiographic abnormalities are rare following SVT ablation in children with structurally normal hearts, independent of the use of 3D mapping.
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Affiliation(s)
- Ari J Gartenberg
- Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Robert H Pass
- Division of Cardiology, Children's Hospital at Montefiore / Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Scott Ceresnak
- Division of Cardiology, Lucile Packard Children's Hospital / Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Lynn Nappo
- Division of Cardiology, Children's Hospital at Montefiore / Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Christopher M Janson
- Division of Cardiology, Children's Hospital at Montefiore / Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA. .,Children's Hospital of Philadelphia, 8NW, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Catheter ablation for supraventricular tachycardia in children ≤ 20 kg using an electroanatomical system. J Interv Card Electrophysiol 2019; 55:99-104. [PMID: 30603855 DOI: 10.1007/s10840-018-0499-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/17/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Catheter ablation is the only choice of treatment in some small children with medically refractory supraventricular tachycardia (SVT). Electroanatomical mapping systems (EMS) are more commonly utilized in electrophysiological procedures in recent years, which resulted in a significant decrease in fluoroscopy exposure. The potential benefit of EMS in small children has not been studied. Therefore, we investigated the outcomes of children undergoing catheter ablation weighing ≤ 20 kg using an electroanatomical mapping system. METHODS This study evaluated the outcomes, characteristics, and follow-ups of children ≤ 20 kg who underwent SVT ablations between April 2012 and April 2018 in a pediatric electrophysiology center where EMS were routinely used. RESULTS In a 6-year period, 1129 children underwent SVT catheter ablation under EMS guidance at our institution. A total of 84 of them were weighing ≤ 20 kg. The acute success rate was 97.6% in 85 tachycardia substrates. No fluoroscopy was used in 58 of the patients, while a median of 5 (4-14) min of fluoroscopy was used in the remaining 26 patients. Recurrences were seen in 4 patients (4.8%) at a mean follow-up of 3.89 ± 2.08 years. Five patients developed non-vital complications (2 right bundle block and 3 temporary complete block that spontaneously resolved during the procedure). CONCLUSIONS The outcome of catheter ablation with the guidance of EMS for the treatment of SVT in small children is favorable. Fluoroscopy exposure can be decreased and even eliminated in most patients.
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Dubin AM, Jorgensen NW, Radbill AE, Bradley DJ, Silva JN, Tsao S, Kanter RJ, Tanel RE, Trivedi B, Young ML, Pflaumer A, McCormack J, Seslar SP. What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous pediatric ablation registries. Heart Rhythm 2019; 16:57-63. [DOI: 10.1016/j.hrthm.2018.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Indexed: 10/28/2022]
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Rosés-Noguer F, Moya-Mitjans Á. Estado actual del tratamiento de las arritmias en la edad pediátrica en España. Buscando su espacio. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2018.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ablación pediátrica con catéter: características y resultados del procedimiento en un centro terciario de referencia. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rosés-Noguer F, Moya-Mitjans Á. Current Situation of the Treatment of Arrhythmias in Children in Spain. Finding a Place of its Own. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:775-778. [PMID: 30100228 DOI: 10.1016/j.rec.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ferran Rosés-Noguer
- Servei de Cardiologia Pediàtrica, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Paediatric Cardiology Department, Royal Brompton Hospital, NHS Fundation Trust, London, United Kingdom; Unitat d'Arítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Instituto de Medicina y Cardiología, Unitat d'Arítmies, Hospital Universitari Dexeus, Barcelona, Spain.
| | - Ángel Moya-Mitjans
- Unitat d'Arítmies, Servei de Cardiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Instituto de Medicina y Cardiología, Unitat d'Arítmies, Hospital Universitari Dexeus, Barcelona, Spain
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Walsh EP. Ebstein’s Anomaly of the Tricuspid Valve. JACC Clin Electrophysiol 2018; 4:1271-1288. [DOI: 10.1016/j.jacep.2018.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/31/2018] [Indexed: 01/29/2023]
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Wright KN, Connor CE, Irvin HM, Knilans TK, Webber D, Kass PH. Atrioventricular accessory pathways in 89 dogs: Clinical features and outcome after radiofrequency catheter ablation. J Vet Intern Med 2018; 32:1517-1529. [PMID: 30216552 PMCID: PMC6189389 DOI: 10.1111/jvim.15248] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/10/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022] Open
Abstract
Background Atrioventricular accessory pathways (APs) in dogs have been reported rarely. Data regarding clinical presentation and long‐term outcome after radiofrequency catheter ablation (RFCA) are limited. Hypothesis/Objectives To study clinical features, electrophysiologic characteristics, and outcome of RFCA in dogs with APs. Animals Eighty‐nine dogs presented consecutively for RFCA of APs. Methods Case series. Results Labrador retrievers (47.2% of dogs) and male dogs (67.4% of dogs) were most commonly affected. Labrador retrievers were more likely to be male than non‐Labrador breeds (P = .043). Clinical signs were nonspecific and most commonly included lethargy and gastrointestinal signs. Concealed APs were more prevalent in Labrador retrievers than other breeds (P = .001). Right‐sided APs (91.7%) predominated over left‐sided (8.3%). Tachycardia‐induced cardiomyopathy (TICM) occurred in 46.1% of dogs, with complete resolution or substantial improvement noted on one‐month postablation echocardiograms. Radiofrequency catheter ablation successfully eliminated AP conduction long term in 98.8% of dogs in which it was performed. Complications occurred in 5/89 dogs. Recurrence in 3 dogs was eliminated long term with a second procedure. Clinical Importance/Conclusions Accessory pathways are challenging to recognize in dogs because of nonspecific clinical signs, frequency of concealed APs that show no evidence of their presence during sinus rhythm, and intermittent occurrence of tachyarrhythmias resulting from APs. Tachycardia‐induced cardiomyopathy commonly occurs with AP‐mediated tachycardias and should be considered in any dog presenting with a dilated cardiomyopathic phenotype because of its good long‐term prognosis with rhythm control. Radiofrequency catheter ablation is a highly effective method for eliminating AP conduction and providing long‐term resolution.
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Affiliation(s)
- Kathy N Wright
- Department of Cardiology, MedVet Medical & Cancer Centers for Pets, Cincinnati, Ohio
| | - Chad E Connor
- Wright-Patterson Air Force Base Medical Center, Wright-Patterson AFB, Ohio.,Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Holly M Irvin
- Department of Cardiology, MedVet Medical & Cancer Centers for Pets, Cincinnati, Ohio
| | - Timothy K Knilans
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dawn Webber
- Department of Cardiology, MedVet Medical & Cancer Centers for Pets, Cincinnati, Ohio
| | - Philip H Kass
- Department of Population Health and Reproduction, University of California-Davis, Davis, California
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Santilli RA, Mateos Pañero M, Porteiro Vázquez DM, Perini A, Perego M. Radiofrequency catheter ablation of accessory pathways in the dog: the Italian experience (2008-2016). J Vet Cardiol 2018; 20:384-397. [PMID: 30131290 DOI: 10.1016/j.jvc.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/20/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Accessory pathways (APs) in dogs are mostly right-sided, display nondecremental conduction, and mediate atrioventricular reciprocating tachycardias (AVRTs). Radiofrequency catheter ablation (RFCA) is considered the first-line therapy in human patients to abolish electrical conduction along APs. ANIMALS Seventy-six consecutive client-owned dogs. MATERIAL AND METHODS Retrospective study to describe the precise anatomical distribution and the electrophysiologic characteristics of APs in a large population of dogs and to evaluate long-term success and complication rates of RFCA. RESULTS Eighty-three APs were identified in 76 dogs (92.1% with single APs and 7.9% with multiple APs); 96.4% were right-sided, 3.6% left-sided. Conduction along the APs was unidirectional and retrograde in 68.7% of the cases and bidirectional in 31.3%. Accessory pathways presented retrograde decremental properties in 6.5% of the cases. They mediated orthodromic AVRT in 92.1% of the cases and permanent junctional reciprocating tachycardia in 6.5%. In one case, no AVRT could be induced. In 97.4% of dogs, RFCA was attempted with an acute success rate of 100%. In 7.7% of cases, recurrence of the tachycardia occurred within 18 months, followed by a second definitively successful ablation. A major complication requiring pacemaker implantation was identified in 2.6% of dogs. DISCUSSION Accessory pathway distribution and electrophysiologic properties in these 76 dogs were similar to previous report. Long-term success and complication rates of RFCA in dogs appeared very similar to results of humans. CONCLUSION Radiofrequency catheter ablation of APs can be performed with a high success rate and low incidence of complications.
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Affiliation(s)
- R A Santilli
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy.
| | - M Mateos Pañero
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | | | - A Perini
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
| | - M Perego
- Clinica Veterinaria Malpensa, Viale Marconi 27, 21017 Samarate, Varese, Italy
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Catheter Ablation in Children With Accessory A-V Pathway: Do Short-Term Results Predict Long-Term Success? JACC Clin Electrophysiol 2018; 4:456-458. [PMID: 30067484 DOI: 10.1016/j.jacep.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 11/20/2022]
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Etheridge SP, Escudero CA, Blaufox AD, Law IH, Dechert-Crooks BE, Stephenson EA, Dubin AM, Ceresnak SR, Motonaga KS, Skinner JR, Marcondes LD, Perry JC, Collins KK, Seslar SP, Cabrera M, Uzun O, Cannon BC, Aziz PF, Kubuš P, Tanel RE, Valdes SO, Sami S, Kertesz NJ, Maldonado J, Erickson C, Moore JP, Asakai H, Mill L, Abcede M, Spector ZZ, Menon S, Shwayder M, Bradley DJ, Cohen MI, Sanatani S. Life-Threatening Event Risk in Children With Wolff-Parkinson-White Syndrome. JACC Clin Electrophysiol 2018; 4:433-444. [DOI: 10.1016/j.jacep.2017.10.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
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Alonso-García A, Atienza F, Ávila P, Ugueto C, Centeno M, Álvarez R, Datino T, González-Torrecilla E, Castellanos E, Loughlin G, Medrano C, Arenal Á, Fernández-Avilés F. Pediatric Catheter Ablation: Characteristics and Results of a Series in a Tertiary Referral Hospital. ACTA ACUST UNITED AC 2018; 71:794-800. [PMID: 29482981 DOI: 10.1016/j.rec.2018.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/10/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Catheter ablation has become the treatment of choice in an increasing number of arrhythmias in children and adolescents. There is still limited evidence of its use at a national level in Spain. The aim was to describe the characteristics and results of a modern monocentric series form a referral tertiary care centre. METHODS Retrospective register of invasive procedures between 2004 and 2016 performed in patients under 17 years and recorded clinical characteristic, ablation methodology and acute and chronic results of the procedure. RESULTS A total of 291 procedures in 224 patients were included. Median age was 12.2 years, 60% male. Overall, 46% patients were referred from other autonomous communities. The most frequent substrates were accessory pathways (AP) (70.2%,>50% septal AP localization) and atrioventricular nodal reentrant tachycardia (AVNRT) (15.8%). Congenital and acquired heart disease was frequent (16.8%). Cryoablation was used in 35.5% of the cases. Overall acute success of the primary procedure was 93.5% (AP 93.8%; AVNRT 100%). Redo procedures after recurrence were performed in 18.9% of all substrates, with a long-term cumulative efficacy of 98.4% (AP 99.3%; AVNRT 100%). One (0.37%) serious complication occurred, a case of complete atrioventricular block. CONCLUSIONS Our study replicated previous international reports of high success rates with scarce complications in a high complexity series, confirming the safety and efficacy of pediatric catheter ablation in our environment performed at highly experienced referral centers.
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Affiliation(s)
- Andrés Alonso-García
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Felipe Atienza
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Pablo Ávila
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Clara Ugueto
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Miriam Centeno
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Reyes Álvarez
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Tomás Datino
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban González-Torrecilla
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Evaristo Castellanos
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Gerard Loughlin
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Constancio Medrano
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ángel Arenal
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Fernández-Avilés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBERCV, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Hino H, Oda Y, Yoshida Y, Suzuki T, Shimada M, Nishikawa K. Electrophysiological effects of desflurane in children with Wolff-Parkinson-White syndrome: a randomized crossover study. Acta Anaesthesiol Scand 2018; 62:159-166. [PMID: 29068040 DOI: 10.1111/aas.13023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/24/2017] [Accepted: 10/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND We hypothesized that, compared with propofol, desflurane prolongs the antegrade accessory pathway effective refractory period (APERP) in children undergoing radiofrequency catheter ablation for Wolff-Parkinson-White (WPW) syndrome. METHODS In this randomized crossover study, children aged 4.1-16.1 years undergoing radiofrequency catheter ablation for WPW syndrome were randomly divided into four groups according to the concentration of desflurane and anesthetics used in the first and the second electrophysiological studies (EPS). After induction of general anesthesia with propofol and tracheal intubation, they received one of the following regimens: 0.5 minimum alveolar concentration (MAC) desflurane (first EPS) and propofol (second EPS) (Des0.5-Prop group, n = 8); propofol (first EPS) and 0.5 MAC desflurane (second EPS) (Prop-Des0.5 group, n = 9); 1 MAC desflurane (first EPS) and propofol (second EPS) (Des1.0-Prop group, n = 10); propofol (first EPS) and 1 MAC desflurane (second EPS) (Prop-Des1.0 group, n = 9). Radiofrequency catheter ablation was performed upon completion of EPS. Sample size was determined to detect a difference in the APERP. RESULTS Desflurane at 1.0 MAC significantly prolonged the APERP compared with propofol, but did not affect the sinoatrial conduction time, atrio-His interval or atrioventricular node effective refractory period. Supraventricular tachycardia was induced in all children receiving propofol, but not induced in 1 and 4 children receiving 0.5 MAC and 1.0 MAC desflurane, respectively. CONCLUSION Desflurane enhances the refractoriness and may block the electrical conduction of the atrioventricular accessory pathway, and is therefore not suitable for use in children undergoing radiofrequency catheter ablation for WPW syndrome.
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Affiliation(s)
- H. Hino
- Department of Anesthesiology; Osaka City General Hospital; Osaka Japan
| | - Y. Oda
- Department of Anesthesiology; Osaka City General Hospital; Osaka Japan
| | - Y. Yoshida
- Department of Pediatric Electrophysiology; Pediatric Medical Care Center; Osaka City General Hospital; Osaka Japan
| | - T. Suzuki
- Department of Pediatric Electrophysiology; Pediatric Medical Care Center; Osaka City General Hospital; Osaka Japan
| | - M. Shimada
- Department of Anesthesiology; Osaka City Juso Hospital; Osaka Japan
| | - K. Nishikawa
- Department of Anesthesiology; Osaka City University Graduate School of Medicine; Osaka Japan
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Utility of Echocardiography in Detecting Silent Complications After Pediatric Catheter Ablations. Pediatr Cardiol 2017; 38:1426-1433. [PMID: 28711964 DOI: 10.1007/s00246-017-1680-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
Although transcatheter arrhythmia ablation (TCA) has been performed in children for over two decades, guidelines for routine use of post-ablation transthoracic echocardiography (TTE) are absent. We sought to determine the efficacy of TTE after apparently uneventful TCA procedures in detecting adverse findings and identify predisposing factors. A retrospective review of clinical and procedural data on patients who underwent TCA for supraventricular arrhythmias from 2000 to 2015 was performed. Pre- and post-ablation TTE data were reviewed. All patients were followed at 1 week, 6 and 12 months post-TCA. A repeat TTE was performed at 12 months on patients in whom post-TCA abnormalities were found. Patients were divided into two groups: those with and without adverse TTE findings and comparative analysis between variables was performed. Data on 252 patients, 52% males, mean age 14 ± 3 years were analyzed. New onset or worsening atrioventricular valve regurgitation occurred in 17 (6.7%), a small pericardial effusion in 3 (1.2%) and worsened ventricular function in 2 patients (0.8%). Patients in the complication group had higher mean number of ablations (22.6 ± 15.3 vs. 16.8 ± 9.2, p 0.001) and required longer duration of ablation (sec) (254.6 ± 256.4 vs. 180.9 ± 158.9, p < 0.001). TCA location (including coronary sinus), energy source, arrhythmia substrate, and a trans-septal approach were noncontributory to any adverse findings. Routine post-ablation TTE uncovers asymptomatic self-resolving abnormalities that typically do not require any intervention.
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Cho Y. Supraventricular Tachycardia in Special Population. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2017. [DOI: 10.18501/arrhythmia.2017.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Swissa M, Birk E, Dagan T, Abby Naimer S, Fogelman M, Einbinder T, Bruckheimer E, Fogelman R. Limited fluoroscopy catheter ablation of accessory pathways in children. J Cardiol 2017; 70:382-386. [PMID: 28274505 DOI: 10.1016/j.jjcc.2016.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/20/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children. METHODS Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP). RESULTS The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, p<0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications. CONCLUSIONS A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.
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Affiliation(s)
- Moshe Swissa
- Kaplan Medical Center, Rehovot, The Hebrew University, Jerusalem, Israel.
| | - Einat Birk
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Tamir Dagan
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Sody Abby Naimer
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Fogelman
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Tom Einbinder
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Elchanan Bruckheimer
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Fogelman
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
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