Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-21T00:27:43.706Z Has data issue: false hasContentIssue false
  • English
  • Français

Catheter ablation of focal atrial tachycardia in children using three-dimensional electroanatomic mapping system: a 6-year single-centre experience

Published online by Cambridge University Press:  14 December 2020

Gulhan Tunca Sahin ,
Hasan Candas Kafali Open the ORCID record for Hasan Candas Kafali [Opens in a new window] ,
Erkut Ozturk Open the ORCID record for Erkut Ozturk [Opens in a new window] ,
Alper Guzeltas  and
Yakup Ergul
Gulhan Tunca Sahin
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
Hasan Candas Kafali
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
Erkut Ozturk
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
Alper Guzeltas
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
Yakup Ergul*
Affiliation:
Department of Pediatric Cardiology, Istanbul Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
*
Author for correspondence: Yakup Ergul, Department of Pediatric Cardiology, Director of Pediatric Electrophysiology, Istanbul Saglik Bilimleri University Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey, Phone: +90 542 256 06 01; Tel: +90 212 692 20 00; Fax: +90 212 471 94 94. E-mail: yakupergul77@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This study demonstrates the clinical and electrophysiological details of catheter ablation conducted in children with focal atrial tachycardia using three-dimensional electroanatomic mapping systems.

Patients and methods:

Electrophysiological procedures were performed using the EnSite™ system.

Results:

Between 2014 and 2020, 60 children (median age 12.01 years [16 days–18 years]; median weight 41.5 kg [3–98 kg]) with focal atrial tachycardia and treated with catheter ablation were evaluated retrospectively. Tachycardia-induced cardiomyopathy was developed in 15 patients (25%). Most of the focal atrial tachycardia foci were right-sided (75%), and more than one focus was found in four patients. Radiofrequency ablation was performed in 47 patients (irrigated radiofrequency ablation in seven cases), cryoablation in 9, and radiofrequency ablation and cryoablation in the same session in 4 patients. The median procedural time was 163.5 minutes (82–473 minutes). Fluoroscopy was used in 29 of (48.3%) patients (especially for left-side substrate) with a mean time of 8.6 ± 6.2 minutes. The acute success rate was 95%. The procedure failed in three patients, and recurrence was observed in 3.5% of patients (2/57) during a median follow-up of 17 months (2–69 months). The second ablation was performed in four cases, of which three were successful. Overall success rate was 96.6% with no major complications observed, except in one patient with minimal pericardial effusion.

Conclusion:

Catheter ablation seems to be an effective and safe treatment in focal atrial tachycardia. Electroanatomic mapping system can facilitate the ablation procedure and minimise radiation exposure.

Keywords

Focal atrial tachycardiacatheter ablationlimited fluoroscopychildren
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 5 , May 2021 , pp. 744 - 750
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Case, CL, Gillette, PC. Automatic atrial and junctional tachycardias in the pediatric patient: strategies for diagnosis and management. PACE 1993; 16: 1323–1335.10.1111/j.1540-8159.1993.tb01719.xCrossRefGoogle ScholarPubMed
Rosso, R, Kistler, PM. Focal atrial tachycardia. Heart (British Cardiac Society) 2010; 96: 181–185.10.1136/hrt.2008.143552CrossRefGoogle ScholarPubMed
Chiladakis, JA, Vassilikos, VP, Maounis, TN, Cokkinos, DV, Manolis, AS. Successful radiofrequency catheter ablation of automatic atrial tachycardia with regression of the cardiomyopathy picture. PACE 1997; 20: 953–959.10.1111/j.1540-8159.1997.tb05499.xCrossRefGoogle ScholarPubMed
Medi, C, Kalman, JM, Haqqani, H, et al. Tachycardia-mediated cardiomyopathy secondary to focal atrial tachycardia: long-term outcome after catheter ablation. J Am Coll Cardiol 2009; 53: 1791–1797.10.1016/j.jacc.2009.02.014CrossRefGoogle ScholarPubMed
Brugada, J, Blom, N, Sarquella-Brugada, G, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace 2013; 15: 1337–1382.10.1093/europace/eut082CrossRefGoogle Scholar
Salerno, JC, Kertesz, NJ, Friedman, RA, Fenrich, AL Jr. Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children < 3 or >or =3 years of age. J Am Coll Cardiol 2004; 43: 438–444.10.1016/j.jacc.2003.09.031CrossRefGoogle ScholarPubMed
Campbell, RM, Strieper, MJ, Frias, PA, et al. Quantifying and minimizing radiation exposure during pediatric cardiac catheterization. Pediatr Cardiology 2005; 26: 29–33.CrossRefGoogle ScholarPubMed
Kottkamp, H, Hindricks, G, Breithardt, G, Borggrefe, M. Three-dimensional electromagnetic catheter technology: electroanatomical mapping of the right atrium and ablation of ectopic atrial tachycardia. J Cardiovasc Electrophysiol 1997; 8: 1332–1337.10.1111/j.1540-8167.1997.tb01029.xCrossRefGoogle ScholarPubMed
Steinbeck, G, Hoffmann, E. ‘True’ atrial tachycardia. Eur Heart J 1998; 19 (Suppl E): E10-12–e48-19.Google ScholarPubMed
Toyohara, K, Fukuhara, H, Yoshimoto, J, Ozaki, N, Nakamura, Y. Electrophysiologic studies and radiofrequency catheter ablation of ectopic atrial tachycardia in children. Pediatr Cardiology 2011; 32: 40–46.10.1007/s00246-010-9809-3CrossRefGoogle ScholarPubMed
Dieks, JK, Muller, MJ, Schneider, HE, et al. Catheter ablation of pediatric focal atrial tachycardia: ten-year experience using modern mapping systems. Pediatr Cardiology 2016; 37: 459–464.10.1007/s00246-015-1299-xCrossRefGoogle ScholarPubMed
Cummings, RM, Mahle, WT, Strieper, MJ, et al. Outcomes following electroanatomic mapping and ablation for the treatment of ectopic atrial tachycardia in the pediatric population. Pediatr Cardiology 2008; 29: 393–397.10.1007/s00246-007-9137-4CrossRefGoogle ScholarPubMed
Kang, KT, Etheridge, SP, Kantoch, MJ, et al. Current management of focal atrial tachycardia in children: a multicenter experience. Circ Arrhythmia Electrophysiol 2014; 7: 664–670.10.1161/CIRCEP.113.001423CrossRefGoogle ScholarPubMed
Elkiran, O, Akdeniz, C, Karacan, M, Tuzcu, V. Electroanatomic mapping-guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy. PACE 2019; 42: 453–457.10.1111/pace.13619CrossRefGoogle ScholarPubMed
Balla, C, Foresti, S, Ali, H, et al. Long-term follow-up after radiofrequency ablation of ectopic atrial tachycardia in young patients. J Arrhythmia 2019; 35: 290–295.10.1002/joa3.12172CrossRefGoogle ScholarPubMed
Bauersfeld, U, Gow, RM, Hamilton, RM, Izukawa, T. Treatment of atrial ectopic tachycardia in infants < 6 months old. Am Heart J 1995; 129: 1145–1148.10.1016/0002-8703(95)90396-8CrossRefGoogle ScholarPubMed
Roberts-Thomson, KC, Kistler, PM, Kalman, JM. Focal atrial tachycardia II: management. PACE 2006; 29: 769–778.10.1111/j.1540-8159.2006.00433.xCrossRefGoogle ScholarPubMed
Walsh, EP, Saul, JP, Hulse, JE, et al. Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation 1992; 86: 1138–1146.10.1161/01.CIR.86.4.1138CrossRefGoogle ScholarPubMed
Houmsse, M, Daoud, EG. Biophysics and clinical utility of irrigated-tip radiofrequency catheter ablation. Expert Rev Med Devices 2012; 9: 59–70.CrossRefGoogle ScholarPubMed
Triedman, JK, DeLucca, JM, Alexander, ME, Berul, CI, Cecchin, F, Walsh, EP. Prospective trial of electroanatomically guided, irrigated catheter ablation of atrial tachycardia in patients with congenital heart disease. Heart Rhythm 2005; 2: 700–705.10.1016/j.hrthm.2005.03.017CrossRefGoogle ScholarPubMed
Kistler, PM, Roberts-Thomson, KC, Haqqani, HM, et al. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol 2006; 48: 1010–1017.10.1016/j.jacc.2006.03.058CrossRefGoogle ScholarPubMed
Lee, G, Sanders, P, Kalman, JM. Catheter ablation of atrial arrhythmias: state of the art. Lancet (London, England) 2012; 380: 1509–1519.10.1016/S0140-6736(12)61463-9CrossRefGoogle ScholarPubMed
De Giovanni, JV, Dindar, A, Griffith, MJ, et al. Recovery pattern of left ventricular dysfunction following radiofrequency ablation of incessant supraventricular tachycardia in infants and children. Heart (Br Card Soc) 1998; 79: 588–592.Google ScholarPubMed
Clay, MA, Campbell, RM, Strieper, M, Frias, PA, Stevens, M, Mahle, WT. Long-term risk of fatal malignancy following pediatric radiofrequency ablation. Am J Cardiol 2008; 102: 913–915.10.1016/j.amjcard.2008.05.033CrossRefGoogle ScholarPubMed
Kugler, JD, Danford, DA, Houston, KA, Felix, G. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002; 13: 336–341.10.1046/j.1540-8167.2002.00336.xCrossRefGoogle ScholarPubMed