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LaPage MJ, Reed JH, Collins KK, Law IH, Pilcher TA, Tanel RE, Anderson CC, Young ML, Emmel M, Paul T, Blaufox AD, Arora G, Saul JP. Safety and results of cryoablation in patients <5 years old and/or <15 kilograms. Am J Cardiol 2011; 108:565-71. [PMID: 21624545 DOI: 10.1016/j.amjcard.2011.03.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022]
Abstract
Current recommendations discourage elective radiofrequency ablation in patients <5 years old and/or weighing <15 kg, primarily because of the greater complication rate. To describe the current use, complications, and immediate outcomes of cryoablation in this patient population, a multicenter retrospective review of all patients <5 years old and/or weighing <15 kg who were treated with cryoablation for arrhythmia was performed. Eleven centers contributed data for 68 procedures on 61 patients. Of those, 34% were elective and 24% (n = 16) were both cryoablation and radiofrequency ablation. The median age and weight at ablation was 3.5 years (range 8 days to 9.9 years) and 15.2 kg (range 2.3 to 23), respectively. Congenital heart disease was present in 23% of the patients. The immediate success rate of cryoablation alone was 74%. No major complications occurred with cryoablation only; however, 2 of the 16 patients who underwent cryoablation and radiofrequency ablation had major complications. Of the 50 patients receiving cryoablation, 8 (16%) had variable degrees of transient atrioventricular block. The recurrence rate was 20% after cryoablation and 30% after cryoablation plus radiofrequency ablation. In conclusion, cryoablation appears to have a high safety profile in these patients. Compared to older and larger patients, the efficacy of cryoablation in this small, young population was lower and the recurrence rates were higher. Cryoablation's effect on the coronary arteries has not been fully elucidated and requires additional research.
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Seo CH, Shi Y, Huang SW, Kim K, O'Donnell M. Thermal strain imaging: a review. Interface Focus 2011; 1:649-64. [PMID: 22866235 PMCID: PMC3262277 DOI: 10.1098/rsfs.2011.0010] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2011] [Accepted: 04/21/2011] [Indexed: 11/12/2022] Open
Abstract
Thermal strain imaging (TSI) or temporal strain imaging is an ultrasound application that exploits the temperature dependence of sound speed to create thermal (temporal) strain images. This article provides an overview of the field of TSI for biomedical applications that have appeared in the literature over the past several years. Basic theory in thermal strain is introduced. Two major energy sources appropriate for clinical applications are discussed. Promising biomedical applications are presented throughout the paper, including non-invasive thermometry and tissue characterization. We present some of the limitations and complications of the method. The paper concludes with a discussion of competing technologies.
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Affiliation(s)
| | - Yan Shi
- Philips Research, Briarcliff Manor, NY, USA
| | | | - Kang Kim
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew O'Donnell
- Department of Bioengineering, University of Washington, Seattle, WA, USA
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103
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Risk vs Benefit for Catheter Ablation in the Small Child: When Does the Bough Break? Can J Cardiol 2011; 27:523.e1-2. [DOI: 10.1016/j.cjca.2011.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Accepted: 11/22/2010] [Indexed: 11/23/2022] Open
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Seo CH, Stephens DN, Cannata J, Dentinger A, Lin F, Park S, Wildes D, Thomenius KE, Chen P, Nguyen T, de La Rama A, Jeong JS, Mahajan A, Shivkumar K, Nikoozadeh A, Oralkan O, Truong U, Sahn DJ, Khuri-Yakub PT, O'Donnell M. The feasibility of using thermal strain imaging to regulate energy delivery during intracardiac radio-frequency ablation. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2011; 58:1406-17. [PMID: 21768025 PMCID: PMC3177537 DOI: 10.1109/tuffc.2011.1960] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A method is introduced to monitor cardiac ablative therapy by examining slope changes in the thermal strain curve caused by speed of sound variations with temperature. The sound speed of water-bearing tissue such as cardiac muscle increases with temperature. However, at temperatures above about 50°C, there is no further increase in the sound speed and the temperature coefficient may become slightly negative. For ablation therapy, an irreversible injury to tissue and a complete heart block occurs in the range of 48 to 50°C for a short period in accordance with the well-known Arrhenius equation. Using these two properties, we propose a potential tool to detect the moment when tissue damage occurs by using the reduced slope in the thermal strain curve as a function of heating time. We have illustrated the feasibility of this method initially using porcine myocardium in vitro. The method was further demonstrated in vivo, using a specially equipped ablation tip and an 11-MHz microlinear intracardiac echocardiography (ICE) array mounted on the tip of a catheter. The thermal strain curves showed a plateau, strongly suggesting that the temperature reached at least 50°C.
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Affiliation(s)
- Chi Hyung Seo
- University of California, Davis, Department of Biomedical Engineering, Davis, CA, USA
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Khairy P, Guerra PG, Rivard L, Tanguay JF, Landry E, Guertin MC, Macle L, Thibault B, Tardif JC, Talajic M, Roy D, Dubuc M. Enlargement of Catheter Ablation Lesions in Infant Hearts With Cryothermal Versus Radiofrequency Energy. Circ Arrhythm Electrophysiol 2011; 4:211-7. [DOI: 10.1161/circep.110.958082] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Paul Khairy
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Peter G. Guerra
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Lena Rivard
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Jean-François Tanguay
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Evelyn Landry
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Marie-Claude Guertin
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Laurent Macle
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Bernard Thibault
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Jean-Claude Tardif
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Mario Talajic
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Denis Roy
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
| | - Marc Dubuc
- From the Electrophysiology Service and Research Center, Montreal Heart Institute, and the Biostatistics Service, Montreal Heart Institute Coordinating Centre, Université de Montréal, Montreal, Canada
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Strieper M, Leong T, Bajaj T, Huckaby J, Frias P, Campbell R. Does Ablation of Supraventricular Tachycardia in Children with a Structurally Normal Heart Improve Quality of Life? CONGENIT HEART DIS 2010; 5:587-93. [DOI: 10.1111/j.1747-0803.2010.00398.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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107
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Li CH, Hu YF, Lin YJ, Chang SL, Lo LW, Ta-Chuan T, Lee PC, Huang SY, Suenari K, Tung NH, Tai CT, Chao TF, Chiang CE, Chen SA. The impact of age on the electrophysiological characteristics and different arrhythmia patterns in patients with Wolff-Parkinson-White syndrome. J Cardiovasc Electrophysiol 2010; 22:274-9. [PMID: 21040092 DOI: 10.1111/j.1540-8167.2010.01906.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Information about the impact of age on the electrophysiological characteristics of accessory pathways (APs) in patients with Wolff-Parkinson-White (WPW) syndrome remains limited. METHODS AND RESULTS A total of 1,885 consecutive patients (mean age 43 ± 17 years, male 61.5%) with WPW syndrome who were referred to the tertiary center for an electrophysiological study and radiofrequency catheter ablation were investigated. The patients were divided into 4 groups based on their age (Group 1: <20; Group 2: 20-39; Group 3: 40-59; Group 4: ≧60 years old). With age, more left-sided APs (53.2%, 67.7%, 71.7%, 75.7%, P < 0.001) and a longer duration of the arrhythmia (4.3 ± 2.8 years, 10.1 ± 7.0 years, 12.4 ± 10.9 years, 14.0 ± 12.4 years, P < 0.001) were noted. The incidence of concealed APs (53.5%, 53.0%, 57.8%, 60.9%, P = 0.01), and orthodromic atrioventricular (AV) reentrant tachycardia (92.4%, 94.2%, 96.5%, 96.3%, P = 0.023) increased with age. The tachycardia cycle length, antegrade (275.5 ± 42.2 ms, 286.7 ± 62.7 ms, 302.5 ± 66.5 ms, 315.2 ± 80.2 ms, P < 0.001) and retrograde AP effective refractory periods (APERPs) (254.0 ± 42.5 ms, 263.3 ± 51.8 ms, 274.5 ± 100.5 ms, 292.7 ± 57.0 ms, P < 0.001), atrial ERP, antegrade AV node effective refractory period (AVNERP), and ventricular effective refractory period (VERP) lengthened as the age increased. The incidence of decremental APs, multiple APs, and a catecholamine response were similar. The duration of the catheter ablation, total fluoroscopy time, acute success rate, complication rate, and incidence of a secondary procedure were similar between the different age groups. CONCLUSION The electrophysiological characteristics and pattern of the arrhythmic attack associated with the AP changed with age.
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Affiliation(s)
- Cheng-Hung Li
- Division of Cardiology, Taipei Veterans General Hospital, #201 Sec. 2 Shih-Pai Road, Taipei, Taiwan
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108
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Olgun H, Karagoz T, Celiker A. Coronary microcatheter mapping of coronary arteries during radiofrequency ablation in children. J Interv Card Electrophysiol 2010; 27:75-9. [PMID: 19937099 DOI: 10.1007/s10840-009-9445-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 09/15/2009] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Radiofrequency catheter ablation (RFCA) is a safe and effective treatment option for children with refractory supraventricular tachycardias. RFCA of right-sided accessory pathways (APs) continues to be challenging, resulting in lower success rates and higher recurrence rates. One of the reasons for a prolonged or failed procedure is mapping error and changes in cardiac anatomy. The right coronary artery (RCA) runs along the ventricular aspect of the right epicardial atrioventricular groove, and RCA mapping had been reported facilitating difficult right-sided AP RFCA in the pediatric population. We reported that microcatheter-assisted mapping during RFCA can improve localization of right-sided and some left-sided APs particularly in children with congenital heart disease. METHODS This technique was used in seven patients with a mean age of 15.3+/-1.6 years and a mean weight of 52.6+/-6.5 kg. Five patients (71%) had manifest preexcitation on surface electrocardiogram, and two patients had a concealed AP. In two of them, there were single ventricle anatomies. In the other two patients, venous access problem to the heart and enormous cardiac hypertrophy were the major problems. In the remaining three patients with normal cardiac anatomy, RCA mapping was used because a standard procedure was not successful. Previous RFCA ablation was not successful in two patients. Either a 150-cm eight-electrode pair (2-6-2 mm, 2.5 French) or a four-electrode pair (2-6-2 mm, 2.3 French) microcatheter (2.3 French octapolar microcatheter) was used. RESULTS Average time of the multielectrode RCA mapping was 42+/-14.5 min. All eight (100%) APs were successfully ablated. No complications occurred. CONCLUSIONS Microcatheter-assisted coronary artery mapping during RFCA is a useful adjunctive mapping technique in children with difficult to map right-sided APs and patients with APs who has complex cardiovascular anomalies.
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Affiliation(s)
- Hasim Olgun
- Department of Pediatrics and Division of Pediatric Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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109
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Accidente cerebrovascular isquémico asociado con ablación por radiofrecuencia de reentrada nodal. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70222-9] [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] Open
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110
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Chang YM, Wang JK, Chiu SN, Lin MT, Wu ET, Chen CA, Huang SC, Chen YS, Chang CI, Chiu IS, Lin JL, Lai LP, Wu MH. Clinical spectrum and long-term outcome of Ebstein's anomaly based on a 26-year experience in an Asian cohort. Eur J Pediatr 2009; 168:685-90. [PMID: 18781325 DOI: 10.1007/s00431-008-0820-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2008] [Revised: 08/08/2008] [Accepted: 08/11/2008] [Indexed: 10/21/2022]
Abstract
Ebstein's anomaly is a rare, congenital cardiac anomaly that may result in cyanosis, right heart failure, and tachyarrhythmia during the newborn stage or after adolescence. This study investigated the data of 77 patients diagnosed between 1980 and 2006 at a tertiary care center in Taiwan. Patients were grouped into either an early group or a late group. Survival declined rapidly within the newborn stage in the early group, but declined only during the third decade in the late group. Surgical results were poor (20% success rate) for neonatal systemic-to-pulmonary shunts in those cases with associated pulmonary atresia, but were satisfactory for other surgical modes. Supraventricular tachyarrhythmia occurred in 31 (41%) patients at a median age of 10 years and could be eliminated by radiofrequency ablation (81% success rate), though the recurrence rate was high (41%). In conclusion, other than those cases requiring shunts at the newborn stage, the long-term outcome was favorable.
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Affiliation(s)
- Ya-Mei Chang
- Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University, No. 7, Chun-Shan Road, Taipei, Taiwan.
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Ferlini M, Colli AM, Bonanomi C, Salvini L, Galli MA, Salice P, Ravaglia R, Centola M, Danzi GB. Flecainide as first-line treatment for supraventricular tachycardia in newborns. J Cardiovasc Med (Hagerstown) 2009; 10:372-5. [DOI: 10.2459/jcm.0b013e328329154d] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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112
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Schneider HE, Kriebel T, Gravenhorst VD, Paul T. Incidence of coronary artery injury immediately after catheter ablation for supraventricular tachycardias in infants and children. Heart Rhythm 2009; 6:461-7. [DOI: 10.1016/j.hrthm.2009.01.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 01/23/2009] [Indexed: 10/21/2022]
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113
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Van Hare GF. Pediatric Electrophysiology Series–Catheter ablation in children. Heart Rhythm 2009; 6:423-5. [DOI: 10.1016/j.hrthm.2008.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Indexed: 12/01/2022]
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Ohm OJ, Hoff PI, Aasen LM, Solheim E, Schuster P, Off MK, Chen J. [Catheter ablation of tachyarrhythmias in children and adolescents]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2009; 129:291-5. [PMID: 19219094 DOI: 10.4045/tidsskr.09.34367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Catheter ablation has been increasingly applied in children and adolescents with tachyarrhythmias. The aim of this article is to assess the results of ablation therapy of tachycardias in patients below 18 years of age at Haukeland University Hospital. MATERIAL AND METHODS 141 patients (70 boys and 71 girls, aged 5-17 (13.5 +/- 3.5 ) years with tachyarrhythmias underwent an electrophysiologic study and catheter ablation in the period 1992-2007. RESULTS Ablation was successfully performed in 138/141 (98%) patients., The procedure was repeated (3 patients twice) until the arrhythmia substrate disappeared in 16 of 138 patients. 81/141 (57%) patients had accessory pathways; 52 (37%) had double atrioventricular nodal pathways, 48 had concealed and 33 patients had overt (classical Wolff-Parkinson-White-syndrome) atrioventricular pathways. 8 (6%) patients had other atrial or ventricular tachyarrhythmias and 4 (3%) had organic heart disease. Use of a 3D mapping system was decisive for success for ablation in patients with complex cardiac diseases. Procedure-related complications were observed in 2/141 (1.4%) patients of whom one had a temporary third degree and one had a permanent first-degree atrioventricular block which did not entail further treatment. CONCLUSION Catheter ablation of tachycardia in children and adolescents is a safe treatment method with a high success rate and few complications and should be preferred before drug therapy.
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Fujii K, Iranami H, Nakamura Y, Hatano Y. Fentanyl Added to Propofol Anesthesia Elongates Sinus Node Recovery Time in Pediatric Patients with Paroxysmal Supraventricular Tachycardia. Anesth Analg 2009; 108:456-60. [DOI: 10.1213/ane.0b013e31819002d4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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116
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Harahsheh A, Du W, Singh H, Karpawich PP. Risk factors for atrioventricular tachycardia degenerating to atrial flutter/fibrillation in the young with Wolff-Parkinson-White. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:1307-12. [PMID: 18811812 DOI: 10.1111/j.1540-8159.2008.01182.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atrioventricular reciprocating tachycardia (AVRT) is common in patients (pts) with Wolff-Parkinson-White (WPW) syndrome but atrial flutter/fibrillation (AF) with rapid ventricular response (RVR) is rare. Although AF occurs in 18% of adult WPW pts, its incidence in children is unknown. We sought to determine risk factors for AVRT spontaneously degenerating to AF during electrophysiologic studies (EPS) in children with WPW. METHODS This was a retrospective study of children with WPW referred for accessory pathway (AP) ablation without clinical AF. Standard electrophysiologic protocols were performed to induce AVRT. To determine if AF degeneration was associated with patient characteristics, 2-sample t-tests, Chi-square, and Fisher's exact were used. RESULTS There were 53 (31 males) WPW pts studied. During EPS, AVRT degenerated to AF in 27/53 (51%). RVR was seen in 18/27 (67%) patients. The ventricular cycle length (CL) during AF was shorter with RVR (211 + 24 ms) than without (313 + 65 ms) (P = 0.01). AF occurred more commonly among patients with right anterior AP (P = 0.05). Patient gender, age, height, weight, body surface area, persistence of preexcitation on exercise testing, baseline CL, AVRT conduction, and AP number were not significant AF determinants. The AVRT CL was significantly shorter in patients with (265.2 + 41.5 ms) versus those without (308 + 59 ms) AF (P = 0.01). Preliminary data suggest that AP location may be related to patient ethnicity. CONCLUSION AF with RVR occurred following AVRT induction during EPS in 34% of our WPW patients, typically associated with right-sided AP locations. Time intervals for RVR to degenerate into ventricular fibrillation and lead to SCD are yet to be determined.
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Affiliation(s)
- Ashraf Harahsheh
- Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA
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Cadrin-Tourigny J, Fournier A, Andelfinger G, Khairy P. Severe left ventricular dysfunction in infants with ventricular preexcitation. Heart Rhythm 2008; 5:1320-2. [DOI: 10.1016/j.hrthm.2008.05.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Accepted: 05/22/2008] [Indexed: 11/28/2022]
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Delise P, Sciarra L. Asymptomatic Wolff-Parkinson-White: what to do. Extensive ablation or not? J Cardiovasc Med (Hagerstown) 2007; 8:668-74. [PMID: 17700395 DOI: 10.2459/jcm.0b013e3280103994] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Van Hare GF, Colan SD, Javitz H, Carmelli D, Knilans T, Schaffer M, Kugler J, Byrum CJ, Saul JP. Prospective assessment after pediatric cardiac ablation: fate of intracardiac structure and function, as assessed by serial echocardiography. Am Heart J 2007; 153:815-20, 820.e1-6. [PMID: 17452159 PMCID: PMC1950149 DOI: 10.1016/j.ahj.2007.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2006] [Accepted: 02/12/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Catheter ablation puts cardiac valves at risk of damage, and children are of particular concern. METHODS A multicenter prospective study was performed to assess the results and risks associated with radiofrequency (RF) ablation in children. Patients were aged 0 to 16 years with supraventricular tachycardia due to accessory pathway or atrioventricular node reentry, excluding patients with more than trivial congenital heart disease. A total of 481 patients were recruited into the prospective cohort and were followed up at 2, 6 and, 12 months after ablation. Complete echocardiograms were obtained before and at intervals after RF ablation, and they were reviewed by experts who were blinded with respect to diagnosis, outcome, pathway site, and study interval. RESULTS Moderate valve insufficiency was quite rare (0.12%), but mild insufficiency was common, both before ablation (42.43%) and at 2 months after ablation (40.49%). Analysis of paired readings failed to demonstrate a tendency toward increased insufficiency of valves adjacent to ablation targets, with the exception of the tricuspid valve after the ablation of right freewall pathways and atrioventricular node reentry, but the degree of change was small. No clear changes in left ventricular systolic or diastolic function were observed, and dyskinesis was rare and not related to the ablation target. No intracardiac thrombosis was observed. CONCLUSIONS Serious injury to cardiac valves due to RF ablation is very rare, but the tricuspid valve may be mildly affected in some cases. We identified no clear effect of RF ablation on cardiac wall motion or on left ventricular function.
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Affiliation(s)
- George F Van Hare
- The Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, CA 94304, USA.
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121
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Lee PC, Hwang B, Tai CT, Chiang CE, Chen SA. The Specific Electrophysiologic Characteristics in Children with the Atypical Forms of Atrioventricular Nodal Reentrant Tachycardia. Cardiology 2007; 108:351-7. [PMID: 17308382 DOI: 10.1159/000099108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Accepted: 10/26/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) is well known to be one of the most common supraventricular tachycardias in childhood. However, information about the atypical forms of AVNRT in childhood is limited. The purpose of this retrospective study was to investigate the clinical and electrophysiologic characteristics in pediatric patients with the atypical forms of AVNRT. METHODS One hundred and three pediatric patients with AVNRT were included (aged 8-18 years; 44 male, 59 female). There were 10 (9.7%) children with the atypical forms (group 1), 86 (83.4%) with the slow-fast form (group 2) and 7 (6.9%) with the fast-slow form of AVNRT (group 3). The electrophysiologic characteristics and results of the radiofrequency catheter ablation were compared among these 3 groups. RESULTS Group 2 patients were associated with an older age when compared with the other two groups. A significantly higher incidence of retrograde dual atrioventricular nodal pathways and a higher percentage of ventricular pacing- and extrastimulation-induced AVNRT were demonstrated in the children with the fast-slow form of AVNRT. The children with the atypical forms of AVNRT had a greater difference in the antegrade 1:1 conduction (100 +/- 73 vs. 52 +/- 41 vs. 35 +/- 26 ms, p = 0.003). Furthermore, the children with the slow-fast form of AVNRT had a greater difference in the retrograde 1:1 conduction (125 +/- 97 vs. 42 +/- 35 vs. 65 +/- 79 ms, p = 0.012). CONCLUSION This study demonstrated that the pediatric patients with the atypical forms of AVNRT had different electrophysiologic characteristics than those with the slow-fast or fast-slow forms of AVNRT. The results of radiofrequency catheter ablation were similar for all children with the slow-fast, fast-slow and atypical forms of AVNRT.
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Affiliation(s)
- Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.
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Liberman L, Hordof AJ, Pass RH. Rapid Atrial Pacing: A Useful Technique During Slow Pathway Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:221-4. [PMID: 17338719 DOI: 10.1111/j.1540-8159.2007.00653.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Catheter ablation is the treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT) with a success rate of 95-98%. The appearance of junctional rhythm during radiofrequency (RF) application to the slow pathway has been consistently reported as a marker for the successful ablation of AVNRT. Ventriculoatrial (VA) conduction during junctional rhythm has been used by many as a surrogate marker of antegrade atrioventricular nodal (AVN) function. However, VA conduction may not be an accurate or consistent marker for antegrade AVN function and reliance on this marker may leave some patients at risk for antegrade AVN injury. OBJECTIVE The purpose of this study is to describe a technique to ensure normal antegrade AVN function during junctional rhythm at the time of RF catheter ablation of the slow pathway. METHODS Retrospective review of all patients less than 21 years old who underwent RF ablation for AVNRT at our institution from January 2002 to July 2005. During RF applications, immediately after junctional rhythm was demonstrated, RAP was performed to ensure normal antegrade AVN function. Postablation testing was performed to assess AVN function and tachycardia inducibility. RESULTS Fifty-eight patients underwent RF ablation of AVNRT during the study period. The mean age +/- SD was 14 +/- 3 years (range: 5-20 years). The weight was 53 +/- 15 Kg (range: 19-89 Kg). The preablation Wenckebach cycle length was 397 +/- 99 msec (range: 260-700 msec). Fifty-four patients had inducible typical AVNRT, and four patients had atypical tachycardia. The mean tachycardia cycle length +/- SD was 323 +/- 62 msec (range: 200-500 msec). Patients underwent of 8 +/- 7 total RF applications (median: 7; range 1 to 34), for a total duration of 123 +/- 118 seconds (median: 78 sec, range: 20-473 sec). Junctional tachycardia was observed in 52 of 54 patients. RAP was initiated during junctional rhythm in all patients. No patient developed any degree of transient or permanent AVN block. Following ablation, the Wenckebach cycle length decreased to 364 +/- 65 msec (P < 0.01). Acutely successful RF catheter ablation was obtained in 56 of 58 patients (96%). CONCLUSION Rapid atrial pacing during radiofrequency catheter ablation of the slow pathway is a safe alternative approach to ensure normal AVN function.
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Affiliation(s)
- Leonardo Liberman
- Pediatric Arrhythmia Service, Division of Pediatric Cardiology, New York-Presbyterian Hospital, Columbia University, New York, New York, USA.
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123
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Movahed MR. Thomadsen Bruce R, Rivard Mark J, Butler Wayne M: Brachytherapy Physics. Biomed Eng Online 2006. [PMCID: PMC1352367 DOI: 10.1186/1475-925x-5-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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124
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Bar-Cohen Y, Cecchin F, Alexander ME, Berul CI, Triedman JK, Walsh EP. Cryoablation for accessory pathways located near normal conduction tissues or within the coronary venous system in children and young adults. Heart Rhythm 2006; 3:253-8. [PMID: 16500293 DOI: 10.1016/j.hrthm.2005.11.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 11/30/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cryoablation may offer advantages over radiofrequency (RF) ablation for certain arrhythmia substrates, such as septal accessory pathways (APs). Data for young patients, especially regarding recurrence risk, require expansion. OBJECTIVES The purpose of this study was to study institutional outcomes for cryoablation of APs located in potentially difficult septal regions for children and young adults. METHODS Cryoablation was attempted in 35 young patients (mean age 15.6 years) with 37 APs that were either close to normal conduction tissues or inside the coronary venous system. Outcomes were compared with previously published institutional data for RF ablation at these same locations. RESULTS Acute cryoablation success was achieved for 29 (78%) of 37 APs. Apart from permanent PR prolongation in one case and right bundle branch block in one other, there were no detrimental effects on normal conduction. At median follow-up of 207 days (range 2-695 days), AP conduction recurred for 13 (45%) of 29 ablated APs. Younger patient age and midseptal AP location correlated with higher likelihood of recurrence. Acute success rates for cryoablation were similar to RF ablation in our laboratory, but recurrence rates were significantly higher (P <.001). CONCLUSION Cryoablation yields acute success rates comparable with RF ablation for difficult septal APs in young patients. The risk of AP recurrence appears higher after cryoablation, although safety benefits may provide suitable compensation for this deficiency. Methods for creating more effective cryoablation lesions need to be explored.
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Affiliation(s)
- Yaniv Bar-Cohen
- Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
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Papagiannis J, Tsoutsinos A, Kirvassilis G, Sofianidou I, Koussi T, Laskari C, Kiaffas M, Apostolopoulou S, Rammos S. Nonfluoroscopic Catheter Navigation for Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:971-8. [PMID: 16981921 DOI: 10.1111/j.1540-8159.2006.00472.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation (RCA) of supraventricular tachycardia (SVT) in children is highly successful but requires exposure to radiation. Nonfluoroscopic mapping systems may significantly reduce fluoroscopy time. METHODS Forty consecutive pediatric patients who underwent RCA for accessory pathways (AP) or AV nodal reentrant tachycardia (AVNRT) with use of a nonfluoroscopic navigation system (Ensite NavX) (group A) were compared retrospectively to 40 consecutive patients with similar diagnoses who underwent RCA with fluoroscopic guidance only (group B). RESULTS Group A (mean age 12.1+/-2.9 years, mean weight 47+/-13.9 kg) consisted of 11 patients (27.7%) with AVNRT and 29 (72.5%) with AP. Group B (mean age 10.9+/-3.1 years, mean weight 47.1+/-17.1 kg) consisted of 7 patients (17.5%) with AVNRT and 33 (82.5%) with AP. There were no significant differences in AP location, patients with congenital heart disease, and number of radiofrequency lesions. Fluoroscopy time was significantly shorter in group A than in group B (10.4+/-6.1, range 3.1-28.8 minutes, vs 24.9+/-16.0, range 4.4-82.0 minutes, P<0.0001). Procedure duration was also significantly shorter in group A than in group B (170+/-68.5, range 90-420 minutes, vs 218+/-69.3, range 90-360 minutes, P<0.0001). Initial success was 95% in group A and 100% in group B. Tachycardia recurrences occurred in two patients in group A (5%) and six patients in group B (15%). Final success, including repeat ablations for recurrences or failures, was 100% in both groups. CONCLUSIONS The use of a nonfluoroscopic system for catheter navigation significantly reduced fluoroscopy exposure and total procedure duration of RCA of common SVT substrates in children.
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Affiliation(s)
- John Papagiannis
- Division of Pediatric Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
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Papez AL, Al-Ahdab M, Dick M, Fischbach PS. Transcatheter cryotherapy for the treatment of supraventricular tachyarrhythmias in children: A single center experience. J Interv Card Electrophysiol 2006; 15:191-6. [PMID: 16915363 DOI: 10.1007/s10840-006-9012-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 05/03/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Transcatheter cryotherapy is an emerging technology for the treatment of children with supraventricular tachyarrhythmias. Limited data exist regarding the use of cryoablation therapy in children. We report a single center's experience with transcatheter cryoablation in the pediatric population. METHODS AND RESULTS A retrospective review of demographic, procedural and outcome data was performed for patients undergoing cryoablation for treatment of supraventricular tachycardia (SVT). A historical control group was taken from the 3 years preceding the introduction of cryoablation. Between August 2003 and November 2005, 83 cryoablation procedures were performed in 81 patients (age: 4 to 21 years, mean: 13.4 years) for AV nodal reentrant tachycardia (AVNRT--53), AV reentrant tachycardia (AVRT--20), ectopic atrial tachycardia (EAT--9), and junctional ectopic tachycardia (JET--1). The acute success rate for all procedures was 88% (AVNRT: 96%, AVRT: 85%, EAT: 55%, and JET: 100%). Of 72 patients that underwent successful cryoablation, nine experienced recurrence of SVT (12.5%). The control group consisted of 73 patients (AVNRT--60, AVRT--13). There were no differences in demographic data between the two groups. The overall success rate for the RFA group (96%) was identical to that for patients with AVNRT and AVRT undergoing cryoablation. The recurrence rate for RFA (10%) was less but not significantly different than that for cryoablation (12%). There were no complications in either group. CONCLUSIONS Cryoablation is a safe and effective alternative for the treatment of SVT in children.
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Affiliation(s)
- Andrew L Papez
- University of Michigan Congenital Heart Center, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
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Vida VL, Calvimontes GS, Macs MO, Aparicio P, Barnoya J, Castañeda AR. Radiofrequency catheter ablation of supraventricular tachycardia in children and adolescents : feasibility and cost-effectiveness in a low-income country. Pediatr Cardiol 2006; 27:434-9. [PMID: 16830085 DOI: 10.1007/s00246-006-1220-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Accepted: 02/08/2006] [Indexed: 11/27/2022]
Abstract
The objective of this study is to provide results and costs of catheter ablation in children and adolescents in a low-income country. Reports from first-world countries have demonstrated the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared to medical treatment of supraventricular tachycardia (SVT). The study included 28 patients younger than 18 years of age with SVT in a pediatric cardiology unit in Guatemala. All patients underwent RFCA. Clinical outcome and cost-effectiveness of RFCA compared to continued medical treatment were the end points. Twenty-four patients had successful ablation (85.7%). Mean age at RFCA was 11.42 +/- 3.49 years. Three patients underwent a second ablation, increasing the success rate to 96.4%. One remaining patient is awaiting a second procedure. At a mean follow-up of 13.69 +/- 7.16 months, all 27 patients who had a successful ablation remained in sinus rhythm. Mean cost per procedure was 4.9 times higher than that of medical treatment. However, the estimated cost of catheter ablation equal that of medical therapy after 5.1 years and is 3.4 times less after 20 years. Radiofrequency catheter ablation of SVT in children and adolescents is safe and cost-effective compared to medical therapy. Resources must be judiciously allocated, especially in low-income countries, to treat the largest number of pediatric patients.
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Affiliation(s)
- Vladimiro L Vida
- Department of Pediatric Cardiovascular Surgery, UNICAR, Guatemala City, 01011 Guatemala CA.
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Lee PC, Hwang B, Tai CT, Chiang CE, Chen SA. The Different Ablation Effects on Atrioventricular Nodal Reentrant Tachycardia in Children with and without Dual Nodal Pathways. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:600-6. [PMID: 16784425 DOI: 10.1111/j.1540-8159.2006.00406.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Previous studies in adults have shown a significant shortening of the fast pathway effective refractory period (ERP) after successful slow pathway ablation. However, information on atrioventricular nodal reentrant tachycardia (AVNRT) in children is limited. The purpose of this retrospective study was to investigate the different effects of radiofrequency (RF) catheter ablation in pediatric AVNRT patients between those with and without dual atrioventricular (AV) nodal pathways. METHODS From January 1992 to August 2004, a total 67 pediatric patients with AVNRT underwent an electrophysiologic study and RF catheter ablation at our institution. We compared the electrophysiologic characteristics between those obtained before and after ablation in the children with AVNRT with and without dual AV nodal pathways. RESULTS Dual AV nodal pathways were found in 37 (55%) of 67 children, including 36 (54%) with antegrade and 10 (15%) with retrograde dual AV nodal pathways. The antegrade and retrograde fast pathway ERPs in children with dual AV nodal pathways were both longer than the antegrade and retrograde ERPs in children without dual AV nodal pathways (300 +/- 68 vs 264 +/- 58 ms, P = 0.004; 415 +/- 70 vs 250 +/- 45 ms, P < 0.001) before ablation. In children with antegrade dual AV nodal pathways, the antegrade fast pathway ERP decreased from 300 +/- 68 ms to 258 +/- 62 ms (P = 0.008). The retrograde fast pathway ERP also decreased after successful ablation in the children with retrograde dual AV nodal pathways (415 +/- 70 vs. 358 +/- 72 ms, P = 0.026). CONCLUSION The dual AV nodal physiology could not be commonly demonstrated in pediatric patients with inducible AVNRT. After a successful slow pathway ablation, the fast pathway ERP shortened significantly in the children with dual AV nodal pathways.
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Affiliation(s)
- Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
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129
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Nielsen JC, Kottkamp H, Piorkowski C, Gerds-Li JH, Tanner H, Hindricks G. Radiofrequency ablation in children and adolescents: results in 154 consecutive patients. ACTA ACUST UNITED AC 2006; 8:323-9. [PMID: 16635987 DOI: 10.1093/europace/eul021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS The experience of using radiofrequency ablation (RFA) for the treatment of arrhythmias in children and adolescents is still limited. This study aimed to review the most recent results of RF ablation in children and adolescents in a highly experienced centre with access to both conventional techniques and non-fluoroscopic electroanatomic mapping (CARTO). METHODS AND RESULTS A total of 154 consecutive patients younger than 19 years treated with RFA during the period 2000-04 were included. Numbers (%) or median (quartiles) are reported. Age was 15 (12-17) years, 70 (45%) were males. Five patients (3%) had congenital heart disease. RFA was successful in 147/154 patients (95%). Arrhythmia recurrence occurred in 11 patients (7%). Procedure time was 55 (35-90) min and fluoroscopy time was 8.8 (4-19) min. Number of RF applications was 4 (2-10) and number of RF applications >20 s was 2 (1-7). One patient (0.7%) had complicating high-grade atrioventricular block. CARTO was used in 18 RF ablation procedures (11%) performed in 15 patients. CONCLUSION RF ablation can be undertaken in children and adolescents with a high success rate, few recurrences and complications, very short procedure times, and acceptable fluoroscopy times. Non-fluoroscopic electroanatomic mapping is helpful in selected patients.
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130
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Kannankeril PJ. Catheter ablation for atrioventricular nodal reentry tachycardia in children: A time to freeze, and a time to burn. Heart Rhythm 2006; 3:571-2. [PMID: 16648063 DOI: 10.1016/j.hrthm.2006.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Indexed: 10/24/2022]
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131
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Zhong JQ, Dorian P, Zhang W, Li L, Zhang Y. Using Transthoracic Two-Dimensional Echocardiography to Guide the Placement of Coronary Sinus Catheters: A Randomized Study. Echocardiography 2006; 23:93-6. [PMID: 16445724 DOI: 10.1111/j.1540-8175.2006.00179.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the value of transthoracic echocardiography (TTE) as an image guide in placing a coronary sinus catheter into the coronary sinus. METHODS Sixty consecutive patients undergoing electrophysiologic study were randomized to TTE (30 patients, "TTE group") or x-ray fluoroscopy (30 patients, "x-ray group") as an image guide to assist in the placement of a coronary sinus catheter. RESULTS The success rate of placing the coronary sinus catheter was 96.7% in TTE group and 100% in x-ray group (P > 0.05). The procedure duration was 5.8 +/- 5.7 minutes in TTE group and 5.9 +/- 3.3 minutes in x-ray group (P > 0.05), The x-ray exposure time was 0.15 +/- 0 minute in TTE group and 4.2 +/- 2.8 minutes in x-ray group (P < 0.0001). CONCLUSION Using TTE as an image guide, coronary sinus cannulation is feasible and as rapid as standard x-ray fluoroscopy, without the radiation risk.
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Affiliation(s)
- Jing-Quan Zhong
- Cardiology Division, Qi Lu Hospital of Shan Dong University, China.
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132
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Affiliation(s)
- Eun-Jung Bae
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
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133
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Joung B, Lee M, Sung JH, Kim JY, Ahn S, Kim S. Pediatric Radiofrequency Catheter Ablation Sedation Methods and Success, Complication and Recurrence Rates. Circ J 2006; 70:278-84. [PMID: 16501293 DOI: 10.1253/circj.70.278] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There remains to be issues regarding radiofrequency catheter ablation (RFCA) in pediatric patients that are different to those involving adults. This study was performed to determine the efficacy and safety of RFCA in pediatric patients. METHODS AND RESULTS During the period from 1992 to 2003, 2,734 patients underwent RFCA and 131 pediatric patients who were < or =15 years old (70 males, mean age 12.0+/-3.1 years) were analyzed, retrospectively. The number of accessory pathways (APs) mediating atrioventricular re-entrant tachycardia was 93 (71.4%) and atrioventricular nodal re-entrant tachycardia (AVNRT) was 27 (20.5%). The most common indications for the RFCA were the ;patient's choice' in 94 (71.2%) and 'medically refractory tachycardia' in 29 (22.0%). The age-related indication of the ;patient's choice' was 80.4% (82 of 102) for those >10 years old and 40.0% (12 of 30) for those < or =10 years old (p=0.01). RFCA was performed without sedation in 87.3% (89 of 102) of the subjects >10 years old as compared to 20.0% (6 of 30) of those < or =10 years old (p=0.01). The success rate was 92.8% (90 of 97 APs) for the ablation of APs, and 96.3% (26 of 27) for that of AVNRT. The overall complication rate was 3.8% (5 of 131). During a mean follow-up duration of 13.1+/-2.5 months, the freedom of recurrence was 87.8% (79 of 90) for the arrhythmia associated with APs and 92.3% (24 of 26) for AVNRT. CONCLUSION RFCA in pediatric patients had a good success rate with acceptable recurrence and complication rates when compared to adult patient results. Therefore, RFCA could be considered as the first line of therapy for arrhythmias with concealed and manifested APs and AVNRT in pediatric patients.
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Affiliation(s)
- Boyoung Joung
- Division of Cardiology, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea
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134
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Bae EJ, Ban JE, Lee JA, Jin SM, Noh CI, Choi JY, Yun YS. Pediatric radiofrequency catheter ablation: results of initial 100 consecutive cases including congenital heart anomalies. J Korean Med Sci 2005; 20:740-6. [PMID: 16224145 PMCID: PMC2779268 DOI: 10.3346/jkms.2005.20.5.740] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Radiofrequency catheter ablation (RFCA) has recently become a management option for pediatric tachycardia. We reviewed the records of a total of 100 patients (aged 10 months to 19 yr) who had undergone RFCA, from March 2000 to June 2004. Types of arrhythmia (age, acute success rate) were as follows: atrioventricular reentrant tachycardia (AVRT, 9.0+/-3.7 yr, 66/67), atrioventricular nodal reentrant tachycardia (AVNRT, 13+/-2.5 yr, 16/16), ectopic atrial tachycardia (6.4+/-3.3 yr, 5/5), junctional ectopic tachycardia (10 month, 1/1), ventricular tachycardia (12+/-4.9 yr, 6/6), postsurgical intraatrial reentrant tachycardia (15.6+/-4.1 yr, 2/3), twin node tachycardia (4 yr, 0/1), and His bundle ablation (9 yr, 1/1). The age of AVNRT was older than that of AVRT (p=0.002). Associated cardiac disease was detected in 17 patients, including 6 univentricular patients, and 3 Ebstein's anomaly patients. RFCA for multiple accessory pathways required longer fluoroscopic times than did the single accessory pathway (53.9+/-4.8 vs. 36.2+/-24.1 min; p=0.03), and was associated with a higher recurrence rate (3/9 vs. 3/53; p=0.03). Regardless of the presence or absence of cardiac diseases, the overall acute success rate was 97% without major complications, the recurrence rate was 8.2%, and the final success rate was 97%. This experience confirmed the efficacy and safety of RFCA in the management of tachycardia in children.
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Affiliation(s)
- Eun-Jung Bae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Eun Ban
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-A Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Mi Jin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chung-Il Noh
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Yun Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Soo Yun
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
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Aiyagari R, Saarel EV, Etheridge SP, Bradley DJ, Dick M, Fischbach PS. Radiofrequency ablation for supraventricular tachycardia in children < or =15 kg is safe and effective. Pediatr Cardiol 2005; 26:622-6. [PMID: 16132307 DOI: 10.1007/s00246-004-0849-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Risks associated with radiofrequency ablation (RFA) have been reported to be increased in children < or =15 kg. We sought to compare the safety and efficacy of RFA in children <15 kg with those between 15.1 and 20 kg. Clinical, electrophysiologic, and RFA data for all patients < or =20 kg who underwent RFA for supraventricular tachycardia between January 1994 and January 2003 were reviewed. Patients were divided into those < or =15 kg (group 1, n = 25) and those between 15.1 and 20 kg (group 2, n = 44). The two groups differed significantly in age and weight by design (group 1: mean weight, 11.9 +/- 3.0 kg; age, 2.8 +/- 1.9 years; group 2: weight, 18.0 +/- 1.5 kg; age, 5.1 +/- 1.1 years). There were no significant differences in other baseline characteristics except for incidence of structural heart disease (28% group 1 vs 7% group 2, p < 0.01). No significant differences in mechanism of tachycardia, arrhythmia cycle length, number of total and brief RFA applications, total RFA time, average and maximum RFA temperatures, total procedure duration, short-term success rate (96% group 1 vs 86% group 2, p = 0.17), long-term success rate (91% group 1 vs 89% group 2, p = 0.76), or major complications (8.0% group 1 vs 2.3% group 2, p = 0.39) were found. There were no procedure-related deaths in either group. These data suggest that, in two large volume electrophysiology centers, the procedural risks and outcomes of RFA are similar between patients weighing less than 15 kg and those between 15.1 and 20 kg.
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Affiliation(s)
- R Aiyagari
- C.S. Mott Children's Hospital, University of Michigan Medical Center, 1500 E. Medical Center Drive, L1242 Women's 0204, Ann Arbor, MI 48109-0204, USA
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Kolditz DP, Blom NA, Bökenkamp R, Schalij MJ. Low-energy radiofrequency catheter ablation as therapy for supraventricular tachycardia in a premature neonate. Eur J Pediatr 2005; 164:559-62. [PMID: 15889275 DOI: 10.1007/s00431-005-1686-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 03/31/2005] [Indexed: 11/26/2022]
Abstract
UNLABELLED A premature neonate with hydrops was born at 32 weeks of gestation after successful direct fetal amiodarone therapy via cordocentesis for incessant supraventricular tachycardia. After birth the tachycardia could not be controlled despite high doses of amiodarone and flecainide and the patient developed severe respiratory and circulatory failure. After 3 weeks, weighing 2 kg, he underwent successful and uncomplicated catheter ablation of a left free-wall accessory pathway using low-energy radiofrequency. CONCLUSION radiofrequency catheter ablation is rarely used in neonates, but when used with caution may provide the optimal treatment.
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Affiliation(s)
- Denise P Kolditz
- Department of Paediatric Cardiology, Leiden University Medical Centre LUMC, 9600, 2300 RC, Leiden, The Netherlands
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137
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Van Hare GF. Irrigated catheter ablation of intraatrial reentrant tachycardia and evaluation of new technology. Heart Rhythm 2005; 2:706-7. [PMID: 15992725 DOI: 10.1016/j.hrthm.2005.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Indexed: 11/15/2022]
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Abstract
Several different mechanisms are responsible for paroxysmal supraventricular tachycardia in children. Different forms of tachycardia occur at different age. Atrio-ventricular reentry tachycardia results from the presence of congenital atrio-ventricular bypass tracts and is frequently encountered at all ages. Infants may present with ectopic atrial tachycardia or atrial flutter. Atrio-ventricular node reentry tachycardia becomes more frequent in adolescence. Atrial scarring resulting from open heart surgery predisposes to complex intra-atrial reentry. Certain forms of congenital and acquired heart disease are associated with specific types of arrhythmia. Many children with paroxysmal supraventricular tachycardia do not require any therapy. The decision to proceed with treatment should be based on the frequency and severity of symptoms and on the effect of arrhythmia on the quality of life. Infants require medical treatment because of the difficulty to recognize symptoms of tachycardia and a risk of heart failure. Patients with Wolff-Parkinson-White syndrome as well as those with significant heart disease are at risk of sudden death. Syncope in children with paroxysmal tachycardia may indicate a severe fall in cardiac output from extremely rapid heart rate. Patients with potentially life-threatening arrhythmia should not participate in competitive physical activities. Treatment options have undergone significant evolution over the past decade. Indications for the use of specific antiarrhythmic medications have been refined. Contemporary catheter ablation procedures employ different forms of energy allowing for safe and effective procedures. Catheter ablation is the treatment of choice for symptomatic paroxysmal tachycardia in school children and in some infants who failed medical treatment. Surgery is the preferred treatment in few selected cases. The goal of this review is to present the state of the art approach to the diagnosis and management of paroxysmal supraventricular tachycardia in infants, children and adolescents.
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Affiliation(s)
- Michal J Kantoch
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
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Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G. Prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 2005; 1:188-96. [PMID: 15851152 PMCID: PMC1892227 DOI: 10.1016/j.hrthm.2004.03.067] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Accepted: 03/17/2004] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A multicenter prospective study was performed to assess the results and risks associated with radiofrequency ablation in children. This report focuses on recurrences following initially successful ablation. METHODS Patients recruited for the study were aged 0 to 16 years and had supraventricular tachycardia due to accessory pathways or atrioventricular nodal reentrant tachycardia (AVNRT), excluding patients with more than trivial congenital heart disease. A total of 481 patients were recruited into the prospective cohort and were followed at 2, 6, and 12 months following ablation. RESULTS There were 517 successfully ablated substrates out of 540 attempted (95.7%). Loss to follow-up for individual substrates was 3.3%, 10.6%, and 21.2% at 2, 6, and 12 months, respectively. Recurrence was observed in 7.0%, 9.2%, and 10.7% of these substrates at 2, 6, and 12 months, respectively (adjusted for loss to follow-up as an independent source of data censoring). Recurrence rate varied by substrate location (24.6% for right septal, 15.8% for right free wall, 9.3% for left free wall, and 4.8% for left septal), as well as for AVNRT versus all others (4.8% vs 12.9%) at 12 months. The recurrence rate was higher for substrates ablated using power control but was not a function of whether isoproterenol was used for postablation testing. CONCLUSIONS Recurrence after initially successful ablation occurs commonly in children. It is least common after AVNRT ablation and most common following ablation of right-sided pathways. These results serve as a benchmark for the time course of recurrence following initially successful ablation of supraventricular tachycardia in children.
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Affiliation(s)
- George F Van Hare
- Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California, USA.
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Kugler J. Intention to treat: To the heart of the matter for young patients with ventricular tachycardia. Heart Rhythm 2005; 1:309-10. [PMID: 15851175 DOI: 10.1016/j.hrthm.2004.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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142
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Drago F, De Santis A, Grutter G, Silvetti MS. Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients. J Am Coll Cardiol 2005; 45:1096-103. [PMID: 15808770 DOI: 10.1016/j.jacc.2004.12.048] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 11/29/2004] [Accepted: 12/02/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We investigated the safety and efficacy of cryoablation in the treatment of pediatric patients with accessory pathways (APs) located near the atrioventricular junction and with atrioventricular nodal re-entrant tachycardia (AVNRT). BACKGROUND Few studies concern cryoablation in a significant number of pediatric patients involving treatment for supraventricular tachycardias (SVTs) with the reentry circuit located near the atrioventricular junction. METHODS Twenty-six pediatric patients (age range: 5 to 20 years) were treated; 14 had AVNRT, 10 had Wolff-Parkinson-White syndrome, and 2 had re-entrant SVT due to a concealed AP. Electrophysiologic study was performed with diagnostic catheters, and cryoablations were performed with a 7-F 4-mm-tip catheter (Freezor, CryoCath Technologies Inc., Kirkland, Canada). Cryomapping, used to identify the tissue site for safe arrhythmia ablation, was performed at -30 degrees C for a maximum of 60 s. Cryoablations were from 4 to 8 min long at -75 degrees C. Acute end points were noninducibility of AVNRT by programmed atrial stimulation at baseline or during isoproterenol performed 30 min after procedure, as well as noninducibility and conduction block over the AP. The chronic end point was arrhythmia recurrence after intervention. RESULTS No permanent cryo-related complications or adverse outcomes were reported. Twenty-four (92%) patients were acutely successful. During follow-up (range: 1 to 22 months), seven (29%) acutely successful pediatric patients experienced arrhythmia recurrence. CONCLUSIONS Acute results demonstrate cryoablation of SVTs with the reentry circuit located near the atrioventricular junction to be safe and efficacious in pediatric patients. However, the etiology of recurrences reported after intervention need further investigation.
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Affiliation(s)
- Fabrizio Drago
- Department of Pediatric Cardiology, Bambino Gesù Pediatric Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy.
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143
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Miyazaki A, Blaufox AD, Fairbrother DL, Saul JP. Cryo-ablation for septal tachycardia substrates in pediatric patients. J Am Coll Cardiol 2005; 45:581-8. [PMID: 15708707 DOI: 10.1016/j.jacc.2004.10.051] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 10/12/2004] [Accepted: 10/26/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the efficacy and safety of catheter-based cryo-therapy for septal tachycardia substrates in pediatric patients. BACKGROUND Cryo-therapy may be particularly useful for ablation of septal tachycardias, including atrioventricular nodal re-entry tachycardia (AVNRT), atrioventricular reciprocating tachycardia (AVRT), and ventricular tachycardia (VT) originating high in the conduction system. METHODS Thirty-one pediatric patients (median = 13.7 years, range 5.3 to 19.6 years) with septal tachycardia substrates underwent cryo-ablation (CA). Twenty-two had AVNRT, 8 AVRT, and 1 VT. Applications were considered cryo-maps (CMs) if the temperature set-point was -35 degrees C or the application time was <120 s. Other lesions were considered CAs. RESULTS A total of 242 CMs (4 per patient, range 0 to 40 CMs) and 89 CAs (2 per patient, range 1 to 8 CMs) were performed, for a total cryo-therapy time of 689 s/patient (range 158 to 3,300 s). Procedural success with cryo-therapy was achieved in 27 of 31 patients (87.1%), including two procedures with a His potential at the CA location and three performed in tachycardia. The success rate for AVNRT was higher than for AVRT (95.5% vs. 62.5%, p < 0.05). For AVRT, a sustained effect on accessory pathway conduction occurred -3.3 +/- 4.9 s after reaching -25 degrees C, whereas for those sites at which the effect was transient, the effect took 24.8 +/- 25.5 s (p = 0.07). Transient atrioventricular (AV) block occurred during eight cryo-applications (1 CA, 7 CMs) with immediate return of normal AV conduction upon cessation of application. There were no other complications. CONCLUSIONS Cryo-therapy was used to effectively and safely ablate septal tachycardias in this group of 31 pediatric patients. Cryo-therapy may be more effective for AVNRT than septal AVRT.
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Affiliation(s)
- Aya Miyazaki
- The Children's Heart Program of South Carolina-Medical University of South Carolina, Charleston, South Carolina 29425, USA
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144
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Kirsh JA, Gross GJ, O'Connor S, Hamilton RM. Transcatheter cryoablation of tachyarrhythmias in children. J Am Coll Cardiol 2005; 45:133-6. [PMID: 15629387 DOI: 10.1016/j.jacc.2004.10.049] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Revised: 10/14/2004] [Accepted: 10/18/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We sought to describe the early pediatric experience of transcatheter cryoablation, and identify whether specific arrhythmia substrates and/or ablation locations were particularly suited to cryoablation. BACKGROUND Radiofrequency (RF) ablation has become established therapy for pediatric tachyarrhythmias. However, challenges remain in terms of the safety and efficacy of RF ablation in specific locations; new methods may address these issues. METHODS Prospective data were available for 64 patients age 13 +/- 4 (mean +/- SD) years undergoing cryoablation at 14 centers participating in the Cryocath International Patient Registry. Dysrhythmia duration was 5.0 +/- 4.2 years, with diagnoses of atrioventricular node re-entrant tachycardia (AVNRT) (n=30), anteroseptal (n=11), midseptal (n=5), or other (n=15) accessory pathway (AP) mediated AV re-entry, ventricular tachycardia (VT) (n = 3), and ectopic atrial tachycardia (EAT) (n=2). Two patients had more than one arrhythmia substrate. Transcatheter cryoablation was offered by cardiologist preference after written informed procedural consent of each patient and/or legal guardian. Cryomapping was performed at -30 degrees C and cryoablation was delivered with 4-min applications at -75 degrees C. RESULTS Acute success was achieved in 45 of 65 (69%) cryoablation patients, with best success rates in AVNRT (83%) and right septal AP (75%), and lower success rates in other AP (43%), VT (66%), and EAT (0%). No device-related adverse events were reported. The success of radiofrequency (RF) ablation applied in 14 cryoablation failures was 4 of 4 for AVNRT patients, 1 of 1 for anteroseptal AP patients, 5 of 6 for other AP patients, 0 of 1 for VT patients, and 0 of 2 for EAT patients. CONCLUSIONS Transcatheter cryoablation is a safe and well-tolerated alternative to RF ablation in pediatric patients on the basis of our initial experience. Success is highest in AVNRT and in substrates recognized as technically challenging or risky for RF ablation.
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Affiliation(s)
- Joel A Kirsh
- Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada.
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Sturm M, Hausmann D, Bökenkamp R, Bertram H, Wibbelt G, Paul T. Incidence and time course of intimal plaque formation in the right coronary artery after radiofrequency current application detected by intracoronary ultrasound. ACTA ACUST UNITED AC 2004; 93:884-9. [PMID: 15568148 DOI: 10.1007/s00392-004-0142-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2004] [Accepted: 07/08/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the current clinical use of radiofrequency (RF) catheter ablation in infants and children, the late effects of RF current application at immature myocardium remain unclear. The purpose of this study was to investigate incidence and time course of coronary lesions after RF current application at developing myocardium in an animal model. RESULTS In 10 pigs, 6 weeks of age (13+/-2 kg), RF current (500 kHz) was delivered by temperature guidance (75 degrees C) using a steerable electrode catheter (4 mm tip electrode) over 30-second periods. RF lesions were created at the lateral right atrial wall at the tricuspid valve annulus and the lateral left atrial and ventricular wall at the mitral valve annulus. Subsequent coronary angiography and intracoronary ultrasound (ICUS) of the right coronary artery (RCA) and the left circumflex artery (CX) were performed 3, 6, 9 and 12 months after RF current application. Quantitative coronary angiography did not exhibit any significant stenosis of the vessels during the study period. Intimal lesions of the RCA were documented for the first time at the 6-month study in 3 animals by ICUS (mean plaque area 2.2+/-0.2 mm(2), mean area stenosis 30.4+/-4.0%). There was no significant change in lesion length, area stenosis and plaque area at the 9- and 12-month studies. All 3 coronary artery lesions were confirmed in close proximity to myocardial RF lesions by histological examination 12 months after RF delivery. No intimal plaque formation of the CX was observed. CONCLUSIONS Affection of the RCA as a late sequel after RF current application at the lateral right atrial wall occurred in 3 out of 8 long-term surviving pigs. Three to six months seem to be the time frame for the development of intimal lesions after RF delivery. In this experimental setting, angiography failed to detect these intimal changes. The potential risk of coronary affection may be important for catheter ablation procedures at the right atrial myocardium in infants and small children.
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Affiliation(s)
- M Sturm
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Shah MJ, Jones TK, Cecchin F. Improved Localization of Right‐Sided Accessory Pathways with Microcatheter‐Assisted Right Coronary Artery Mapping in Children. J Cardiovasc Electrophysiol 2004; 15:1238-43. [PMID: 15574170 DOI: 10.1046/j.1540-8167.2004.04100.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Radiofrequency ablation of some right-sided accessory pathways continues to be challenging. The purpose of this study was to evaluate the efficacy of introducing a multielectrode microcatheter in the right coronary artery to localize accessory pathways when conventional mapping was unsuccessful. METHODS AND RESULTS A retrospective study was conducted of all right-sided accessory pathway radiofrequency ablation procedures in which a multielectrode microcatheter as a reference in the right coronary artery was used to assist mapping. Between January 1998 and January 2002, 10 patients (5 males) underwent mapping of 11 accessory pathways with this technique at mean age of 12.3 +/- 3.8 years. Five patients had Ebstein's anomaly of the tricuspid valve. Accessory pathways were identified in the following locations: right anterior 3, right anterolateral 2, right lateral 1, right posterolateral 2, and right posterior 3. Mean procedure time was 285 +/- 70.3 minutes, and fluoroscopy time was 68.7 +/- 21 minutes. Average mapping duration prior to microcatheter insertion in the right coronary artery was 136 +/- 40 minutes. After microcatheter placement in the right coronary artery, the time to successful ablation of accessory pathways was 38 +/- 11 minutes. All 11 (100%) accessory pathways were successfully ablated. CONCLUSION Mapping in the right coronary artery with a microcatheter is an effective method to improve localization and successful ablation of difficult right-sided accessory pathways.
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Affiliation(s)
- Maully J Shah
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.
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Pappone C, Manguso F, Santinelli R, Vicedomini G, Sala S, Paglino G, Mazzone P, Lang CC, Gulletta S, Augello G, Santinelli O, Santinelli V. Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 2004; 351:1197-205. [PMID: 15371577 DOI: 10.1056/nejmoa040625] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventricular fibrillation can be the presenting arrhythmia in children with asymptomatic Wolff-Parkinson-White syndrome. Deaths due to this arrhythmia are potentially preventable. METHODS We performed a randomized study in which prophylactic radiofrequency catheter ablation of accessory pathways was compared with no ablation in asymptomatic children (age range, 5 to 12 years) with the Wolff-Parkinson-White syndrome who were at high risk for arrhythmias. The primary end point was the occurrence of arrhythmic events during follow-up. RESULTS Of the 165 eligible children, 60 were determined to be at high risk for arrhythmias. After randomization, but before any ablation had been performed, the parents withdrew 13 children from the study. Of the remaining children, 20 underwent prophylactic ablation and 27 had no treatment. The characteristics of the two groups were similar. There were three ablation-related complications, one of which led to hospitalization. During follow-up, 1 child in the ablation group (5 percent) and 12 in the control group (44 percent) had arrhythmic events. Two children in the control group had ventricular fibrillation, and one died suddenly. The cumulative rate of arrhythmic events was lower among children at high risk who underwent ablation than among those at high risk who did not. The reduction in risk associated with ablation remained significant after adjustment in a Cox regression analysis. In both the ablation and the control groups, the independent predictors of arrhythmic events were the absence of prophylactic ablation and the presence of multiple accessory pathways. CONCLUSIONS In asymptomatic, high-risk children with the Wolff-Parkinson-White syndrome, prophylactic catheter ablation performed by an experienced operator reduces the risk of life-threatening arrhythmias.
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Affiliation(s)
- Carlo Pappone
- Department of Cardiology, Electrophysiology and Cardiac Pacing Unit, San Raffaele University Hospital, Milan, Italy.
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Kammeraad JAE, Sreeram N, van Driel V, Oliver R, Balaji S. Is routine echocardiography valuable after uncomplicated catheter ablation in children? Cardiol Young 2004; 14:386-8. [PMID: 15680044 DOI: 10.1017/s1047951104004068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We determined the clinical value of routine transthoracic echocardiography performed after catheter ablation of supraventricular tachyarrhythmias in children. Between April 1996 and December 2003, 253 children, of whom 135 male, with the overall group having a median age of 9, ranging from 0.1 to 19 years, underwent 280 uncomplicated radiofrequency catheter ablation procedures for supraventricular tachyarrhythmias at three institutions. In every child, transthoracic Doppler echocardiography was performed before and after the procedure. The pre-ablation transthoracic echocardiograms were normal in all, and this was one of the criterions for inclusion. The post-ablation echocardiogram showed a disorder in four asymptomatic patients. In one patient, with focal atrial tachycardia, ablated via a retrograde aortic approach, there was mild aortic valvar insufficiency. This had resolved 6 months later. Pericardial effusions developed in 3 other children. In 2 the effusions resolved spontaneously but 1 patient required pericardial drainage. This same patient also developed clinically asymptomatic mild aortic insufficiency, which resolved spontaneously within 6 months. Routine echocardiography after uncomplicated catheter ablation procedures is of clinical value, and is especially indicated when a retrograde aortic approach has been used.
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Charng MJ, Lin YJ, Chiu TY, Cheng CM, Ding PYA. Comparison of hemostatic activation created by right- and left-heart radiofrequency catheter ablation. Clin Cardiol 2004; 27:91-6. [PMID: 14979628 PMCID: PMC6654595 DOI: 10.1002/clc.4960270210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thromboembolic complications commonly occur in radiofrequency (RF) ablation procedures (0.6-1.3% of cases). Comparison of hemostatic activation between left and right RF ablation is limited. HYPOTHESIS The purpose of this study was to evaluate platelet and hemostatic activation before, immediately after, and 48 h following left and right myocardial RF ablation procedures. METHODS The subjects were two groups of patients who underwent right-heart (24 patients) and left-heart (20 patients) RF ablation. Blood samples taken before, immediately after, and 48 h after the procedure were tested for changes in platelet and hemostatic activation. RESULTS No indication of clinically symptomatic thromboembolism and no major differences in baseline characteristics and procedure were apparent in either group, except for a higher temperature mode setting (p < 0.001) in the left-heart group. The hemostatic evaluation levels increased significantly by the end of the procedure in both groups and the platelet activation level remained elevated for 48 h after the procedure. The platelet activation level increased insignificantly at the end and 48 h after the procedure. Of the other changes in levels of platelet and hemostatic activation, only an increase in one of the hemostatic levels in the right-heart group at 48 h after procedure was significant (p = 0.01). CONCLUSIONS Our findings suggest that similar hemostatic activation occurred during and immediately after RF ablation in both groups. Sustained elevation of the hemostatic marker after the ablation procedure in the right-heart group was observed as of significant therapeutic and prognostic implications.
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Affiliation(s)
- Min-Ji Charng
- Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan.
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Chetaille P, Walsh EP, Triedman JK. Outcomes of radiofrequency catheter ablation of atrioventricular reciprocating tachycardia in patients with congenital heart disease. Heart Rhythm 2004; 1:168-73. [PMID: 15851148 DOI: 10.1016/j.hrthm.2004.03.064] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 03/16/2004] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Assessment of clinical outcomes of catheter ablation of atrioventricular reciprocating tachycardias in patients with congenital heart disease (CHD). BACKGROUND Atrioventricular reciprocating tachycardias occur in patients with CHD and may be poorly tolerated. METHODS Retrospective review of all 105 such ablations in 83 patients performed between 03/90 and 02/02 at one institution. RESULTS The dominant arrhythmia mechanism was accessory pathway (70 patients, 84%), and the most common indications were drug-refractory tachycardia, life-threatening arrhythmia, and elective presurgical ablation. Congenital heart disease diagnoses were diverse, with one third of patients having Ebstein's anomaly. Twenty patients (24%) had catheter access limited by prior surgeries or occluded vascular access. Of 109 accessory pathways (APs), 74 (68%) were manifestly preexcited, and 71 (65%) were located on the right atrioventricular groove. Fourteen patients (20%) had multiple pathways. There were 2 major complications (1 death, 1 hemorrhage), and 3 minor complications (5.5% of procedures). Acute success rate was 80% per procedure, 82% for left- and 70% for right-sided APs. Acute success rates for patients with Ebstein's anomaly were similar to patients with other CHD diagnoses, but Ebstein's patients were more likely to have recurrence. At 44 +/- 35 months follow-up, successful ablation was achieved in 59% of procedures and 68% of patients, with 19 patients (23%) undergoing one or more repeat ablations. CONCLUSIONS Compared to patients with normal cardiac anatomy, patients with CHD of all varieties have lower rates of acute and long-term success for ablation for atrioventricular reciprocating tachycardias.
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