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Leoni L, Bronzetti G, Colonna D, Porcedda G, Rimini A, Silvetti MS. Diagnosis and treatment of fetal and pediatric age patients (0-12 years) with Wolff-Parkinson-White syndrome and atrioventricular accessory pathways. J Cardiovasc Med (Hagerstown) 2023; 24:589-601. [PMID: 37409656 PMCID: PMC10836786 DOI: 10.2459/jcm.0000000000001484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/16/2023] [Indexed: 07/07/2023]
Abstract
Overt or concealed accessory pathways are the anatomic substrates of ventricular preexcitation (VP), Wolff-Parkinson-White syndrome (WPW) and paroxysmal supraventricular tachycardia (PSVT). These arrhythmias are commonly observed in pediatric age. PSVT may occur at any age, from fetus to adulthood, and its symptoms range from none to syncope or heart failure. VP too can range from no symptoms to sudden cardiac death. Therefore, these arrhythmias frequently need risk stratification, electrophysiologic study, drug or ablation treatment. In this review of the literature, recommendations are given for diagnosis and treatment of fetal and pediatric age (≤12 years) WPW, VP, PSVT, and criteria for sport participation.
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Affiliation(s)
- Loira Leoni
- Cardiology, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padua, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart), Padua
| | - Gabriele Bronzetti
- Cardio-Thoraco-Vascular Department, Sant’Orsola Hospital, University Hospital of Bologna IRCCS, Bologna
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples
| | - Giulio Porcedda
- Unit of Pediatric Cardiology, Anna Meyer Children's Hospital, Florence
| | | | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, and Bambino Gesù Children's Hospital, IRCCS, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart). Rome, Italy
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Silvetti MS. The day after the new little ice age… (or the chronic outcome of pediatric slow pathway cryoablation). Heart Rhythm 2021; 19:270-271. [PMID: 34695577 DOI: 10.1016/j.hrthm.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
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Identifying an appropriate endpoint for cryoablation in children with atrioventricular nodal reentrant tachycardia: Is residual slow pathway conduction associated with recurrence? Heart Rhythm 2021; 19:262-269. [PMID: 34601128 DOI: 10.1016/j.hrthm.2021.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cryoablation is increasingly used to treat atrioventricular nodal reentrant tachycardia (AVNRT) due to its safety profile. However, cryoablation may have higher recurrence than radiofrequency ablation (RFA), and the optimal procedural endpoint remains undefined. OBJECTIVE The purpose of this study was to identify the association of cryoablation procedural endpoints with postprocedural AVNRT recurrence. METHODS We performed a single-center, retrospective analysis of pediatric patients following successful first-time cryoablation for AVNRT between January 1, 2011, and December 31, 2019. Preablation inducibility of AVNRT was recorded. Procedural endpoints, including slow pathway (SP) conduction (presence of jump or echo beats) with and without isoproterenol, were identified. Recurrence was established from clinical notes and/or direct patient contact. RESULTS Of 256 patients, 147 (57%) were assessed on isoproterenol precryoablation, and 171 (47%) were assessed on isoproterenol postcryoablation. Mean cryolesion time was 2586 ± 1434 seconds. Following ablation, 104 (41%) had some evidence of residual SP conduction. With median follow-up time of 1.9 [0.7-3.7] years, recurrence occurred in 14 patients (5%). Complete elimination of SP conduction (with and without isoproterenol) had a hazard ratio for recurrence of 1.26 (95% confidence interval [CI] 0.42-3.8; P = .68) on univariate analysis and 1.39 (95% CI 0.36-5.4; P = .63) on multivariate analysis (including demographics, ablation time, 8-mm cryocatheter, and baseline inducibility). CONCLUSION The observed AVNRT recurrence rate after cryoablation was comparable to that of RFA. The presence of residual SP conduction was not associated with recurrence. This suggests that jump or single echo beat may be an acceptable endpoint in AVNRT cryoablation.
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Hoshiyama T, Ashikaga K, Tsujita K, Shibata Y. Efficacy of cryo-ablation during atrioventricular nodal reentrant tachycardia. Heart Vessels 2020; 36:541-548. [PMID: 33113566 DOI: 10.1007/s00380-020-01717-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
Because of the low atrioventricular (AV) block risk during cryo-ablation, it has become possible to treat AV nodal reentrant tachycardia (AVNRT) during arrhythmia. This study aimed to investigate the clinical outcomes of performing cryo-ablation for AVNRT during arrhythmia. Twenty-three patients with AVNRT treated by cryo-ablation during arrhythmia were enrolled. Cryo-ablation was performed gradually from the bottom to above the paraseptal tricuspid annulus until AVNRT was terminated. If the slow pathway was not eliminated despite cryo-ablation terminating the AVNRT, additional cryo-ablation was performed at a higher site until the slow pathway elimination was achieved. AVNRT was terminated by cryo-ablation in all 23 patients. However, the slow pathway was only eliminated in 6 patients. Among the remaining 17 patients, the slow pathway could not be ablated because transient AV block occurred during cryo-ablation at a higher site in 8 patients; however, cryo-ablation at a higher site successfully eliminated the slow pathway in the other 9 patients. In these 9 patients, the distance from the bottom of tricuspid annulus to the site of slow pathway elimination was significantly longer than that from bottom of tricuspid annulus to the AVNRT termination site (20.1 ± 5.3 vs 14.7 ± 4.5 mm: p = 0.027). During follow-up, AVNRT recurrence was confirmed in 3 patients. In 1 of these 3 patients, even a slow pathway elimination was achieved by cryo-ablation at the AVNRT termination site. The AVNRT termination site may not be the ideal site for performing cryo-ablation.
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Affiliation(s)
- Tadashi Hoshiyama
- Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan. .,Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
| | - Keiichi Ashikaga
- Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Yoshisato Shibata
- Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan
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Pre-excitation cardiac problems in children: recognition and treatment. Eur J Pediatr 2020; 179:1197-1204. [PMID: 32529398 DOI: 10.1007/s00431-020-03701-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The prevalence of ventricular pre-excitation is 0.07-0.2% in the pediatric population. Kent bundle is the most common atrioventricular accessory pathway and Mahaim fiber is relatively rare. Approximately, 30-60% of children with ventricular pre-excitation have onset of atrioventricular reentrant tachycardia. Persistent atrioventricular reentrant tachycardia can lead to tachycardiomyopathy. The anterograde conduction of right accessory pathway might lead to ventricular systolic dyssynchrony which might result in cardiac dysfunction even in patients with no tachycardia onset. This type of dilated cardiomyopathy was named as accessory pathway-induced dilated cardiomyopathy. Antiarrhythmic drugs can be used to acutely terminate tachycardia or taken orally to decrease tachycardia recurrence in the long term. However, antiarrhythmic drugs that can be chosen for children are quite limited. Sotalol has become a new choice. With the maturation of radiofrequency catheter ablation technique, progress in three-dimensional electro-anatomic mapping, use of cryoablation, and accumulation of experience in children with small age and weight, catheter ablation has become the first choice for children with pre-excitation syndrome.Conclusion: For ventricular pre-excitation co-exists with dilated cardiomyopathy, differential diagnosis of tachycardiomyopathy or accessory pathway-induced dilated cardiomyopathy should be considered. Catheter ablation (radiofrequency and cryoablation) is a relatively safe and effective treatment option and has become the first choice to treat children with ventricular pre-excitation. What is Known: • Persistent atrioventricular reentrant tachycardia in children can lead to tachycardiomyopathy; • Antiarrhythmic drugs that can be chosen for children are quite limited. What is New: • The anterograde conduction of right accessory pathway (not related to supraventricular tachycardia) might lead to accessory pathway-induced dilated cardiomyopathy. • Catheter ablation (including radiofrequency and cryoablation) has become the first choice for children with pre-excitation syndrome.
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Schneider HE, Stahl M, Schillinger W, Müller M, Backhoff D, Schill M, Groene N, Krause U, Sigler M, Paul T. Double cryoenergy application (freeze-thaw-freeze) at growing myocardium: Lesion volume and effects on coronary arteries late after energy application. Implications for efficacy and safety in pediatric patients. J Cardiovasc Electrophysiol 2019; 30:1127-1134. [PMID: 31111603 DOI: 10.1111/jce.13993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cryoenergy is accepted as an alternative to radiofrequency ablation (RFA) in childen for ablation of supraventricular tachycardia substrates. Single cryoenergy application has been shown to be inferior to RFA. Double cryoenergy application has therefore been introduced into clinical practice, but experience concerning efficacy is limited. Coronary artery stenosis has been reported as serious complication after RFA for arrhythmia substrates but not after single cryoablation. The purpose of the study was to assess lesion volume (efficacy) and risk of coronary artery damage (safety), late, that is, 6 months, after double cryoenergy application in a piglet model. METHODS Two sequential cycles of cryoenergy were delivered at -75°C for 4 minutes at the atrioventricular groove in five piglets. Animals were restudied after 6 months by coronary angiography and intracoronary ultrasound (ICUS). Ablation lesions were examined histologically and lesion volume was determined by three-dimensional morphometric analysis. RESULTS Cryolesion volume was 174.04 ± 67.18 mm3 for atrial and 238.69 ± 112.1 mm3 for ventricular lesions (P > .05). Ventricular lesions, 4.06 ± 1.05 mm, were significantly deeper than atrial lesions, 3.58 ± 0.78 mm, (P < .05). In two of the 29 lesions, cryoenergy induced minor coronary artery injury with mild medial and adventitial thickening as well as minimal intimal proliferation, which had neither been detected by coronary angiography nor by ICUS. CONCLUSION Late after double cryoenergy application at growing myocardium, subclinical minor affection of the coronary artery wall could be detected with minimal intimal proliferation. As lifetime sequelae of this finding remains unknown, further studies are warranted to address safety of repeated cycles of cryoenergy application for tachycardia substrates in children.
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Affiliation(s)
- Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Maja Stahl
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Wolfgang Schillinger
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | | | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Manfred Schill
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Nehle Groene
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
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Saul JP, LaPage MJ. "A Song of Ice and Fire"-another verse from the world of ablation. J Cardiovasc Electrophysiol 2019; 30:1135-1137. [PMID: 31111600 DOI: 10.1111/jce.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/27/2022]
Abstract
The debate between the use of radiofrequency (RF) or cryoenergy for ablation near the atrioventricular (AV) conducting system or small coronaries has been fueled by the relative efficacies and risks of the two technologies, particularly in smaller hearts. The manuscript by Schneider et al adds another chapter to that ongoing debate.
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Affiliation(s)
- J Philip Saul
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Martin J LaPage
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
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Drago F, Battipaglia I, Di Mambro C. Neonatal and Pediatric Arrhythmias: Clinical and Electrocardiographic Aspects. Card Electrophysiol Clin 2018; 10:397-412. [PMID: 29784491 DOI: 10.1016/j.ccep.2018.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Arrhythmias have acquired a specific identity in pediatric cardiology, but for pediatric cardiologists it has always been difficult to recognize and treat them. Changes in anatomy and physiology result in electrocardiogram features that differ from the normal adult pattern and vary according to the age of the child. Sinus arrhythmia, ectopic atrial rhythm, "wandering pacemaker," and junctional rhythm can be normal characteristics in children (15%-25% of healthy children can have these rhythms on the electrocardiogram). Tachyarrhythmias and bradyarrhythmias must be treated according to the severity of symptoms, and the patient's age and weight.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy.
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy
| | - Corrado Di Mambro
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy
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Reddy CD, Ceresnak SR, Motonaga KS, Avasarala K, Feller C, Trela A, Hanisch D, Dubin AM. Bridge to success: A better method of cryoablation for atrioventricular nodal reentrant tachycardia in children. Heart Rhythm 2017; 14:1649-1654. [DOI: 10.1016/j.hrthm.2017.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 10/19/2022]
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10
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Tuzcu V, Gul EE, Karacan M, Kamali H, Celik N, Akdeniz C. Comparison of 6-mm Versus 8-mm-Tip Cryoablation Catheter for the Treatment of Atrioventricular Nodal Reentrant Tachycardia in Children: A Prospective Study. Pediatr Cardiol 2017; 38:1220-1225. [PMID: 28612086 DOI: 10.1007/s00246-017-1648-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 06/02/2017] [Indexed: 11/29/2022]
Abstract
Due to its safety profile, cryoablation (Cryo) for atrioventricular nodal reentrant tachycardia (AVNRT) is more commonly preferred over radiofrequency (RF) ablation in children in recent years. Recent studies demonstrated high long-term success rates comparable to radiofrequency ablation. The aim of this prospective study was to compare the efficacy and safety of an 8-mm-tip versus 6-mm-tip Cryo catheter in the treatment of AVNRT in children. A total of 125 consecutive patients over 10 years of age with AVNRT were included. EnSite system (St. JudeMedical, St Paul, MN, USA) was used to reduce or eliminate fluoroscopy. The acute procedural success was 100% in both groups. The prodecure duration for the 8-mm-tip group was shorter (151.6 ± 63.2 vs. 126.6 ± 36.7 min, p < 0.01, respectively). Fluoroscopy was used in only 7 patients. The mean follow-up duration was 14.6 ± 8.4 months (median 13.5 months, min. 3 months and max. 27 months). The recurrence rate for AVNRT was also comparable between the two groups (6-mm tip: 9.6 vs. 8-mm tip: 8%). Cryo of AVNRT is a safe and effective procedure with comparable acute and mid-term follow-up success rates using 6-mm and 8-mm-tip catheters in children. In addition, procedure duration is shorter with an 8-mm-tip Cryo catheter.
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Affiliation(s)
- Volkan Tuzcu
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Enes Elvin Gul
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey.
| | - Mehmet Karacan
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Hacer Kamali
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Nida Celik
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Celal Akdeniz
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
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Drago F, Battipaglia I, Russo MS, Remoli R, Pazzano V, Grifoni G, Allegretti G, Silvetti MS. Voltage gradient mapping and electrophysiologically guided cryoablation in children with AVNRT. Europace 2017; 20:665-672. [DOI: 10.1093/europace/eux021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Mario Salvatore Russo
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Romolo Remoli
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Vincenzo Pazzano
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Gino Grifoni
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | | | - Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmias/Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Piazza Sant’Onofrio 4, 00165 Rome, Italy
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Determination of cryothermal injury thresholds in tissues impacted by cardiac cryoablation. Cryobiology 2017; 75:125-133. [DOI: 10.1016/j.cryobiol.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
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Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation. J Interv Card Electrophysiol 2016; 48:333-341. [DOI: 10.1007/s10840-016-0208-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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DRAGO FABRIZIO, RUSSO MARIOSALVATORE, BATTIPAGLIA IRMA, GRIFONI GINO, SILVETTI MASSIMOSTEFANO, REMOLI ROMOLO, PAZZANO VINCENZO, SAPUTO FABIOANSELMO, CIANI MICHELE. The Need for a Lengthier Cryolesion Can Predict a Worse Outcome in 3D Cryoablation of AV Nodal Slow Pathway in Children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1198-1205. [DOI: 10.1111/pace.12947] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/07/2016] [Accepted: 08/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- FABRIZIO DRAGO
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - MARIO SALVATORE RUSSO
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - IRMA BATTIPAGLIA
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - GINO GRIFONI
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - MASSIMO STEFANO SILVETTI
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - ROMOLO REMOLI
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - VINCENZO PAZZANO
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
| | - FABIO ANSELMO SAPUTO
- Pediatric Cardiology and Cardiac Arrhythmias/Syncope Unit; Bambino Gesù Children's Hospital and Research Institute; Rome Italy
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Comparison of cryoablation with 3D mapping versus conventional mapping for the treatment of atrioventricular re-entrant tachycardia and right-sided paraseptal accessory pathways. Cardiol Young 2016; 26:931-40. [PMID: 26365515 DOI: 10.1017/s1047951115001614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
UNLABELLED Aim Transcatheter cryoablation is a well-established technique for the treatment of atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia in children. Fluoroscopy or three-dimensional mapping systems can be used to perform the ablation procedure. The aim of this study was to compare the success rate of cryoablation procedures for the treatment of right septal accessory pathways and atrioventricular nodal re-entry circuits in children using conventional or three-dimensional mapping and to evaluate whether three-dimensional mapping was associated with reduced patient radiation dose compared with traditional mapping. METHODS In 2013, 81 children underwent transcatheter cryoablation at our institution, using conventional mapping in 41 children - 32 atrioventricular nodal re-entry tachycardia and nine atrioventricular re-entry tachycardia - and three-dimensional mapping in 40 children - 24 atrioventricular nodal re-entry tachycardia and 16 atrioventricular re-entry tachycardia. RESULTS Using conventional mapping, the overall success rate was 78.1 and 66.7% in patients with atrioventricular nodal re-entry tachycardia or atrioventricular re-entry tachycardia, respectively. Using three-dimensional mapping, the overall success rate was 91.6 and 75%, respectively (p=ns). The use of three-dimensional mapping was associated with a reduction in cumulative air kerma and cumulative air kerma-area product of 76.4 and 67.3%, respectively (p<0.05). CONCLUSIONS The use of three-dimensional mapping compared with the conventional fluoroscopy-guided method for cryoablation of right septal accessory pathways and atrioventricular nodal re-entry circuits in children was associated with a significant reduction in patient radiation dose without an increase in success rate.
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Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, Cannon B, Clark J, Dick M, Freter A, Kertesz NJ, Kirsh JA, Kugler J, LaPage M, McGowan FX, Miyake CY, Nathan A, Papagiannis J, Paul T, Pflaumer A, Skanes AC, Stevenson WG, Von Bergen N, Zimmerman F. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 2016; 13:e251-89. [DOI: 10.1016/j.hrthm.2016.02.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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Di Mambro C, Drago F, Milioni M, Russo MS, Righi D, Placidi S, Remoli R, Palmieri R, Gimigliano F, Santucci LM, Silvetti MS, Prosperi M. Sports Eligibility After Risk Assessment and Treatment in Children with Asymptomatic Ventricular Pre-excitation. Sports Med 2016; 46:1183-90. [DOI: 10.1007/s40279-016-0475-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pieragnoli P, Paoletti Perini A, Checchi L, Carrassa G, Giomi A, Carrai P, Michelucci A, Padeletti L, Ricciardi G. Cryoablation of typical AVNRT: Younger age and administration of bonus ablation favor long-term success. Heart Rhythm 2015; 12:2125-31. [PMID: 26031373 DOI: 10.1016/j.hrthm.2015.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cryoablation (CA) is an emerging tool for the treatment of supraventricular tachyarrhythmias. Determinants of long-term success still need clarification. OBJECTIVE The purpose of this study was to assess which patients' and procedural features affect the long-term efficacy of CA for typical atrioventricular nodal reentrant tachycardia (AVNRT). METHODS Eighty-five consecutive patients undergoing CA for typical AVNRT were divided into 3 groups of age: group A, ≤20 years, n = 20 (23.5%); group B, 21-50 years, n = 30 (35.3%); group C, ≥51 years, n = 35 (41.2%). CA was performed for 5 minutes at -75°C in all; 4-minute bonus CA was delivered if not contraindicated (ie, transient PR interval lengthening during the first application and narrow triangle of Koch). The efficacy end point was the absence of recurrences at 12-month follow-up. RESULTS CA was acutely successful in all 85 patients (100%). Bonus ablation was performed in 69 (81.2%). No permanent complications were observed. At follow-up, AVNRT recurrences occurred in 9 patients (10.6%): group A, 0 (0%); group B, 2 (6.7%), group C, 7 (20%). Incidence of recurrences was significantly different between age groups (P = .047) and between patients receiving (7.2%) and not receiving (25.0%) bonus CA (P = .038). In multivariable analysis, age groups (odds ratio [OR] 5.917; 95% confidence interval [CI] 1.372-25.518; P = .017) and bonus CA (OR 0.115; 95% CI 0.018-0.724; P = .021) were the only independent predictors of recurrences. Furthermore, age as a continuous variable remained statistically associated with recurrences (OR 1.046; 95% CI 1.002-1.091; P = .038). CONCLUSION CA is effective and safe for typical AVNRT ablation. Younger age and bonus CA administration are independent predictors of success at 12 months. Incidence of recurrences is low in patients younger than 21 years.
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Affiliation(s)
- Paolo Pieragnoli
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | | | - Luca Checchi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
| | - Gianmarco Carrassa
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Andrea Giomi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Paolo Carrai
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Antonio Michelucci
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Luigi Padeletti
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy; Department of Cardiology, Cliniche Gavazzeni, Bergamo, Italy
| | - Giuseppe Ricciardi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Swissa M, Birk E, Dagan T, Fogelman M, Einbinder T, Bruckheimer E, Goldenberg I, Klempfner R, Kirsh JA, Fogelman R. Cryotherapy ablation of parahisian accessory pathways in children. Heart Rhythm 2015; 12:917-25. [DOI: 10.1016/j.hrthm.2015.01.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 11/25/2022]
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Collins KK. Cryoablation, limited fluoroscopy, and more. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1093-4. [PMID: 25139717 DOI: 10.1111/pace.12483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 06/29/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Kathryn K Collins
- Pediatric Arrhythmia Center, Children's Hospital Colorado, University of Colorado, Colorado
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DRAGO FABRIZIO, PLACIDI SILVIA, RIGHI DANIELA, DI MAMBRO CORRADO, RUSSO MARIOSALVATORE, SILVETTI MASSIMOSTEFANO, PALMIERI ROSALINDA, PROSPERI MONICA. Cryoablation of AVNRT in Children and Adolescents: Early Intervention Leads to a Better Outcome. J Cardiovasc Electrophysiol 2014; 25:398-403. [DOI: 10.1111/jce.12339] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/12/2013] [Accepted: 11/21/2013] [Indexed: 11/30/2022]
Affiliation(s)
- FABRIZIO DRAGO
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - SILVIA PLACIDI
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - DANIELA RIGHI
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - CORRADO DI MAMBRO
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - MARIO SALVATORE RUSSO
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - MASSIMO STEFANO SILVETTI
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - ROSALINDA PALMIERI
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
| | - MONICA PROSPERI
- Pediatric Arrhythmia Complex Unit and Syncope Unit; Bambino Gesù Children's Hospital, IRCCS; Palidoro-Fiumicino Rome Italy
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Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. ACTA ACUST UNITED AC 2013; 15:1337-82. [DOI: 10.1093/europace/eut082] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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23
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Drago F, Righi D, Placidi S, Russo MS, Di Mambro C, Silvetti MS, Prosperi M. Cryoablation of right-sided accessory pathways in children: report of efficacy and safety after 10-year experience and follow-up. Europace 2013; 15:1651-6. [DOI: 10.1093/europace/eut122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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SCHNEIDER HEIKEE, STAHL MAJA, KRIEBEL THOMAS, SCHILLINGER WOLFGANG, SCHILL MANFRED, JAKOBI JOHANNES, PAUL THOMAS. Double Cryoenergy Application (Freeze-Thaw-Freeze) at Growing Myocardium: Lesion Volume and Effects on Coronary Arteries Early After Energy Application. Implications for Efficacy and Safety in Pediatric Patients. J Cardiovasc Electrophysiol 2013; 24:701-7. [DOI: 10.1111/jce.12085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - MAJA STAHL
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - THOMAS KRIEBEL
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - WOLFGANG SCHILLINGER
- Department for Cardiology and Pneumology; Georg-August-University, Göttingen; Germany
| | - MANFRED SCHILL
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - JOHANNES JAKOBI
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - THOMAS PAUL
- Department for Pediatric Cardiology and Intensive Care Medicine
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Das S, Law IH, Von Bergen NH, Bradley DJ, Dick M, Etheridge SP, Saarel EV, Frias PA, Strieper MJ, Fischbach PS. Cryoablation therapy for atrioventricular nodal reentrant tachycardia in children: a multicenter experience of efficacy. Pediatr Cardiol 2012; 33:1147-53. [PMID: 22430375 DOI: 10.1007/s00246-012-0273-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT), a common tachycardia in children, is routinely treated by catheter ablation using radiofrequency or cryothermal energy. Acute success rates of 95-97 % are reported for cryoablation, similar to those achieved with radiofrequency ablation (RFA). However, early studies reported higher recurrence rates after cryoablation for treatment of AVNRT than those reported for RFA. This study evaluated the success and recurrence rates for cryoablation in a current cohort of pediatric patients across several institutions. Patients 21 years old or younger with AVNRT who underwent cryoablation at five participating centers between 2004 and 2009 were retrospectively reviewed. Patient demographics and procedural data were extracted from patient records and analyzed. A total of 434 patients with AVNRT who underwent cryoablation were identified. Cryoablation was used as the exclusive ablation method for 379 patients. For 97 % (368/379) of these patients, cryoablation was acutely successful. A higher acute success rate was found with the 6-mm-tip catheter (99 %) than with the 4-mm-tip catheter (91 %) (p < 0.01). Recurrence was experienced by 7.3 % of the patients. Recurrence was more likely for those treated with the 4-mm-tip catheter (6/42, 14 %) than for those who had the larger catheters (12/204, 6 %) No patient experienced permanent heart block. Success and recurrence rates for this cohort of patients were similar to those reported for RFA used to treat AVNRT in pediatric patients. The findings show a higher success rate and a lower recurrence rate after cryoablation with a 6-mm-tip catheter than after use of the 4-mm-tip catheter, with an associated excellent safety profile.
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Affiliation(s)
- Srikant Das
- Sibley Heart Center, Children's Healthcare of Atlanta, Emory University, 2835 Brandywine Road, Ste. 300, Atlanta, GA 30341, USA
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QURESHI MUHAMMADY, RATNASAMY CHRISTOPHER, SOKOLOSKI MARY, YOUNG MINGLON. Low Recurrence Rate in Treating Atrioventricular Nodal Reentrant Tachycardia with Triple Freeze-Thaw Cycles. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 36:279-85. [DOI: 10.1111/j.1540-8159.2012.03514.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 06/16/2012] [Accepted: 07/18/2012] [Indexed: 11/29/2022]
Affiliation(s)
- MUHAMMAD Y. QURESHI
- Department of Pediatrics; Division of Pediatric Cardiology; University of Miami; Miami; Florida
| | | | - MARY SOKOLOSKI
- Department of Pediatrics; Division of Pediatric Cardiology; University of Miami; Miami; Florida
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Cohen MI, Triedman JK, Cannon BC, Davis AM, Drago F, Janousek J, Klein GJ, Law IH, Morady FJ, Paul T, Perry JC, Sanatani S, Tanel RE. PACES/HRS expert consensus statement on the management of the asymptomatic young patient with a Wolff-Parkinson-White (WPW, ventricular preexcitation) electrocardiographic pattern: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology Foundation (ACCF), the American Heart Association (AHA), the American Academy of Pediatrics (AAP), and the Canadian Heart Rhythm Society (CHRS). Heart Rhythm 2012; 9:1006-24. [PMID: 22579340 DOI: 10.1016/j.hrthm.2012.03.050] [Citation(s) in RCA: 218] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Indexed: 10/28/2022]
Affiliation(s)
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- Arizona Pediatric Cardiology Consultants & Phoenix Children's Hospital, Phoenix, AZ, USA
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DE SISTI ANTONIO, TONET JOELCI. Cryoablation of Atrioventricular Nodal Reentrant Tachycardia: A Clinical Review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:233-40. [DOI: 10.1111/j.1540-8159.2011.03244.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Collins KK, Schaffer MS. Use of cryoablation for treatment of tachyarrhythmias in 2010: survey of current practices of pediatric electrophysiologists. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:304-8. [PMID: 21077912 DOI: 10.1111/j.1540-8159.2010.02953.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cryoablation for arrhythmia substrates in pediatrics has been available since 2003. The purpose of this study was to evaluate the current approach of pediatric electrophysiologists to the use of cryoablation in the current era. METHODS We sent an Internet link to an online survey to all members of the Pediatric and Congenital Electrophysiology Society. Individuals and not institutions were surveyed. RESULTS A total of 70 responses were received. Responding physicians were largely invasive pediatric electrophysiologists (94%) who practice at mid- to high-volume centers (>50 ablation procedures/year). Survey responders report that cryoablation was utilized for <50% of the ablation volume, and most utilize it for only 10%. With respect to specific arrhythmia substrates, 41% of responders use cryoablation as first-line therapy for atrioventricular nodal reentrant tachycardia. For accessory pathways, 94% report that cryoablation would only be utilized after mapping the accessory pathway to a "high-risk location." Other arrhythmia substrates considered for cryoablation would be accessory pathways mapped to high-risk areas, junctional ectopic tachycardia, a parahisian ectopic atrial tachycardia, or an atrial tachycardia near the phrenic nerve. CONCLUSION For pediatric electrophysiologists who responded to the survey, radiofrequency energy remains the primary energy source for ablation. The current use of cryoablation technology is directed at arrhythmia substrates near the normal conduction system or other "high-risk" areas.
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Affiliation(s)
- Kathryn K Collins
- Division of Pediatric Cardiology at the University of Colorado, The Children's Hospital, Denver, Colorado, USA.
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30
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CZOSEK RICHARDJ, ANDERSON JEFFERY, MARINO BRADLEYS, CONNOR CHAD, KNILANS TIMOTHYK. Linear Lesion Cryoablation for the Treatment of Atrioventricular Nodal Re-entry Tachycardia in Pediatrics and Young Adults. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1304-11. [DOI: 10.1111/j.1540-8159.2010.02811.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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LaPage MJ, Saul JP, Reed JH. Long-term outcomes for cryoablation of pediatric patients with atrioventricular nodal reentrant tachycardia. Am J Cardiol 2010; 105:1118-21. [PMID: 20381663 DOI: 10.1016/j.amjcard.2009.12.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/03/2009] [Accepted: 12/03/2009] [Indexed: 11/30/2022]
Abstract
The long-term efficacy and complications of cryoablation for pediatric atrioventricular nodal reentrant tachycardia (AVNRT) have not been completely defined. We performed a retrospective review of pediatric patients diagnosed with AVNRT and treated with cryoablation therapy. A total of 73 patients underwent cryoablation for AVNRT from 2003 to 2008. Of the 73 patients, 61 were included in the present study. The mean interval from initial successful ablation was 3 + or - 1 years. Of the 61 patients, 4 had documented recurrence of AVNRT after the initially successful ablation, 3 with late recurrence 1 to 2 years after ablation. Procedural complications consisting of transient atrioventricular block developed in 10 patients, and 2 patients were diagnosed with new arrhythmias after AVNRT ablation (1 with junctional ectopic tachycardia and 1 with left ventricular outflow tract tachycardia originating near the region of the atrioventricular node 3 months after ablation). In conclusion, cryoablation is a safe and effective therapy for AVNRT. Recurrences can develop late, up to 2 years after initially successful ablation.
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DRAGO FABRIZIO, RUSSO MARIOS, SILVETTI MASSIMOS, DE SANTIS ANTONELLA, IODICE FRANCESCA, NASO ONOFRIO MARIATERESA. Cryoablation of Typical Atrioventricular Nodal Reentrant Tachycardia in Children: Six Years’ Experience and Follow-Up in a Single Center. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:475-81. [DOI: 10.1111/j.1540-8159.2009.02623.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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SILVER ERICS, SILVA JENNIFERNA, CERESNAK SCOTTR, CHIESA NANCYA, RHEE EDWARDK, DUBIN ANNEM, AVASARALA KISHOR, VAN HARE GEORGEF, COLLINS KATHRYNK. Cryoablation with an 8-mm Tip Catheter for Pediatric Atrioventricular Nodal Reentrant Tachycardia Is Safe and Efficacious with a Low Incidence of Recurrence. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:681-6. [DOI: 10.1111/j.1540-8159.2010.02706.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Drago F, Russo MS, Silvetti MS, De Santis A, Naso Onofrio MT. 'Time to effect' during cryomapping: a parameter related to the long-term success of accessory pathways cryoablation in children. Europace 2009; 11:630-4. [DOI: 10.1093/europace/eup045] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chanani NK, Chiesa NA, Dubin AM, Avasarala K, Van Hare GF, Collins KK. Cryoablation for atrioventricular nodal reentrant tachycardia in young patients: predictors of recurrence. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 31:1152-9. [PMID: 18834467 DOI: 10.1111/j.1540-8159.2008.01156.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recurrence rates of atrioventricular nodal reentry tachycardia (AVNRT) after cryoablation continue to remain high despite excellent initial success rates. Our objective was to evaluate the clinical outcomes of cryoablation for AVNRT with the 4-mm and 6-mm tip cryoablation catheters in a young population and to elicit predictors of arrhythmia recurrence. METHODS We retrospectively reviewed all patients who underwent cryoablation for AVNRT at the UCSF/Stanford Pediatric Arrhythmia Center from January 2004 to February 2007. RESULTS One hundred fifty-four patients (age 13.7 years (3.2-24.4)) underwent cryoablation for AVNRT of which 144 patients had inducible AVNRT (123 sustained and 21 nonsustained) and 10 had presumed AVNRT. Initial success was achieved in 95% (146/154), with no difference between the 4-mm (93%) and 6-mm (98%) cryoablation catheter tips (P = 0.15). There was no permanent atrioventricular (AV) block. Transient third-degree AV block occurred in nine patients (6%), with no difference between the 4-mm (4%) and 6-mm (9%) tip (P = 0.13). AVNRT recurrence was documented in 14% in a median time of 2.5 months (0.25-20). Recurrences were lower with the 6-mm (9%) versus the 4-mm (18%) tip, but this did not reach statistical significance (P = 0.16). With univariate analysis, a longer fluoroscopy time was the only significant factor associated with recurrence. Multivariate analysis failed to identify any significant predictor of AVNRT recurrence. CONCLUSION Outcomes of cryoablation for AVNRT continue to be good without the complication of AV block. We could not identify any specific parameter associated with AVNRT recurrence. Further improvements in cryoablation technique will be necessary to reduce recurrences.
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Affiliation(s)
- Nikhil K Chanani
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco, California, USA
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36
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Young ML. New techniques of mapping and ablation for tachyarrhythmias in children. Future Cardiol 2008; 4:321-31. [DOI: 10.2217/14796678.4.3.321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Advancement in mapping and ablation technologies in the past decade has made arrhythmia treatment in children safer and more effective. Electroanatomical mapping systems with features of nonfluoroscopic navigation, 3D-geometry construction and color-coded arrhythmia mapping have been extensively used to map and ablate tachycardias in children. In addition, a variety of cooled radiofrequency ablation systems have been used in selected patients to create larger and deeper lesions. Cryoenergy ablation, with its reversible nature of tissue injury during the cooling phase, is emerging as the energy of choice for ablating perinodal arrhythmias to minimize the risk of inadvertent conduction block. Other evolving ablation systems, including cryoballoon, high-intensity focused ultrasound balloon and a hybrid catheter capable of delivering both radiofrequency and cryoenergy, are also under investigation. Finally, a remote navigation system that minimizes radiation exposure and will enable physicians of all skill levels to reach difficult target sites in children is on the horizon.
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Affiliation(s)
- Ming-Lon Young
- Director of Pediatric Cardiac Electrophysiology, and, Director of Pediatric Cardiology (Interim) University of Miami, Division of Pediatric Cardiology, PO Box 016960, R-76, Miami, FL 33101, USA
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Pilcher TA, Saul JP, Hlavacek AM, Haemmerich D. Contrasting effects of convective flow on catheter ablation lesion size: cryo versus radiofrequency energy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:300-7. [PMID: 18307624 DOI: 10.1111/j.1540-8159.2008.00989.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cryoablation has now become an alternative to treat many cardiac arrhythmias, and may be the treatment of choice in some patient populations. We compared the effects of convective flow on large-tip cryo and radiofrequency (RF) lesions dimensions. METHODS Cryoablation and RF ablation were performed on porcine heart sections in a saline bath with varying directed flow rates. Cryoablation was performed for 4 minutes on 50 tissue pieces with tip temperature controlled at -80 degrees C. RF ablation was performed on 50 tissue pieces for 60 seconds at 60 degrees C tip temperature. The pieces were placed in culture media for 24 hours, and then sectioned, stained, and measured. RESULTS Cryoablation and RF lesion sizes varied significantly with flow such that higher flow rates produced smaller cryoablation lesions and larger RF lesions (mean cryoablation volumes: 854 +/- 402, 808 +/- 217, 781 +/- 217, 359 +/- 114, and 292 +/- 117 mm(3), and mean RF volumes: 211 +/- 35, 304 +/- 79, 439 +/- 125, 525 +/- 187, and 597 +/- 126 mm(3) for 0, 1, 2, 3, and 5 L/min flow rates, respectively, P < 0.0005). Trabeculated pieces had larger cryoablation lesions and smaller RF lesions than nontrabeculated ones at higher flow rate (P < 0.005). Cryoablation lesion volume increased as the time to reach -80 degrees C decreased (r(2)= 0.72). CONCLUSION In contrast to RF ablation, cryoablation lesion size is smaller at high flow rates, and larger at low flow rates due to the warming effects of local convective flow. The effects of high flow are reduced in areas of trabeculation, and the time to reach -80 degrees C predicts cryoablation lesion size.
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Affiliation(s)
- Thomas A Pilcher
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina 29425, USA
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AVARI JENNIFERN, JAY KATHLEENS, RHEE EDWARDK. Experience and Results During Transition from Radiofrequency Ablation to Cryoablation for Treatment of Pediatric Atrioventricular Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2008; 31:454-60. [DOI: 10.1111/j.1540-8159.2008.01033.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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KALTMAN JONATHANR, TANEL RONNE, WEGRZYNOWICZ BRADLEY, KOZODOY ERIC, WIEAND TAMMY, ENNIS JEAN, VETTER VICTORIAL, SHAH MAULLYJ. Time and Temperature Profile of Catheter Cryoablation of Right Septal and Free Wall Accessory Pathways in Children. J Cardiovasc Electrophysiol 2008; 19:343-7. [DOI: 10.1111/j.1540-8167.2007.01048.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Collins KK. Another tool for the ablation toolbox. J Cardiovasc Electrophysiol 2007; 19:194-6. [PMID: 18031514 DOI: 10.1111/j.1540-8167.2007.01022.x] [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: 11/28/2022]
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Collins KK, Rhee EK, Kirsh JA, Cannon BC, Fish FA, Dubin AM, Van Hare GF. Cryoablation of Accessory Pathways in the Coronary Sinus in Young Patients: A Multicenter Study from the Pediatric and Congenital Electrophysiology Society's Working Group on Cryoablation. J Cardiovasc Electrophysiol 2007; 18:592-7. [PMID: 17472717 DOI: 10.1111/j.1540-8167.2007.00831.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This is a multicenter retrospective study evaluating the immediate- and mid-term outcomes of cryoablation of accessory pathways in the coronary sinus in children or in patients with congenital heart disease. METHODS AND RESULTS Twenty-one patients (median age 13.0 years, range 2-40) from six institutions were included. The accessory pathways were concealed in 11 and manifest in 10. Of 12 patients who had coronary sinus angiography, two had large coronary sinus diverticula, one had a dilated coronary sinus due to a left superior vena cava to coronary sinus, and one had a "pouch" at the mouth of the coronary sinus. Six patients underwent ablation procedures with cryoablation alone, while in the remaining 15 patients, both cryoablation and radiofrequency ablation were utilized. The ablation procedure included left-sided endocardial mapping via a retrograde or transseptal approach in 13 (62%). Procedural success was achieved with cryoablation in the coronary sinus in 15/21 (71%). Four patients (19%) had successful radiofrequency ablation at the right or left posterior septum. Two patients (10%) had unsuccessful procedures. Of the 15 patients with initially successful cryoablation procedures, six (40%) had arrhythmia recurrences at a median of 17 days (range 1-120). Recurrences could not be explained by differences in patient or procedural variables. CONCLUSION Cryoablation in the coronary venous system in young patients is feasible but associated with a high arrhythmia recurrence rate. Cryoablation techniques and/or equipment need to be improved in order to safely create more permanent lesions in this arrhythmia substrate.
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Affiliation(s)
- Kathryn K Collins
- Department of Pediatrics, Division of Cardiology, University of California, San Francisco, California 94143-0632, USA.
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