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Acute outcomes of three-dimensional mapping for fluoroscopy reduction in paediatric catheter ablation for supraventricular tachycardia

Published online by Cambridge University Press:  26 March 2021

Chris Anderson
Affiliation:
Center for Congenital Heart Disease, Providence Sacred Heart Children’s Hospital, Spokane, WA, USA
Maryam Rahman*
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
David J. Bradley
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Kristen Breedlove
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
Macdonald Dick
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Martin J. LaPage
Affiliation:
Division of Pediatric Cardiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
Alaina R. Martinez
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
Neil L. McNinch
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
Jeremy P. Moore
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
John Papagiannis
Affiliation:
Division of Cardiology, Children’s Mercy Hospital, Kansas City, MO, USA
Mansour Razminia
Affiliation:
Clinical Cardiac Electrophysiology, Amita Health Saint Joseph Hospital, Elgin, IL, USA
Kevin M. Shannon
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, UCLA Mattel Children’s Hospital, Los Angeles, CA, USA
Lisa M. Shauver
Affiliation:
Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
Volkan Tuzcu
Affiliation:
Department of Pediatric Cardiology/Electrophysiology, Istanbul Medipol University Hospital, Istanbul, Turkey
John M. Clark
Affiliation:
The Heart Center, Akron Children’s Hospital, Akron, OH, USA
*
Author for correspondence: Dr M. Rahman, The Heart Center, Akron Children’s Hospital, One Perkins Square, Akron, OH44308, USA. Tel: +543 8521. Fax: 330-543-8208. E-mail: mrahman@akronchildrens.org

Abstract

Background:

Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study.

Methods:

Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications.

Results:

In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01).

Conclusions:

In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press

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