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Drago F, Flore F, Blandino R, Secinaro A, Cazzoli I, Raimondo C, Di Mambro C. CT-scan-guided-irrigated trans-catheter ablation of epicardial accessory pathways in the coronary sinus: safety and feasibility in pediatric patients. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01921-9. [PMID: 39316346 DOI: 10.1007/s10840-024-01921-9] [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: 06/21/2024] [Accepted: 09/17/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND The most common site of epicardial APs is posterior-septal, and ablation from the coronary sinus (CS) or its main tributaries is needed. However, particularly in children, it can carry a considerable risk of complications, such as coronary artery (CA) injury, CS damage, and perforation. This study aims to assess the efficacy and safety of computed tomography (CT)-scan-guided-irrigated trans-catheter (TC) ablation of epicardial APs through the CS in children. METHODS Twenty-four children (19 males; mean age 13.8 ± 2.6) with posterior-septal and left posterior epicardial APs who underwent an endocavitary electrophysiological study (EPS) and TC ablation from the CS were enrolled in this study. All patients underwent a CT scan to visualize the CS and its branches and their proximity to the CAs before the ablation. Clinical, electrophysiological and follow-up data were collected. RESULTS Acute success rate was 87.5% (21 out of 24 procedures). No complications occurred. In 16 (66.7%) patients, the ablation site was detected at the proximal CS, in two (8.3%) patients in the mid-proximal CS and in six (25%) in the middle cardiac vein (MCV). Ablation was achieved using an irrigated radiofrequency (RF) catheter in all patients and without the use of fluoroscopy in 20 patients (83.3%). Over a median follow-up of 15.1 months (IQR 2.5-32.3), no recurrences or complications occurred. CONCLUSION Epicardial posterior-septal and left posterior APs, in the area of CS or MCV, can be definitively eliminated in most children using CT-scan-guided electro-anatomical mapping and transvenous irrigated RF ablation.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4 00165, Rome, Italy.
| | - Francesco Flore
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4 00165, Rome, Italy
| | - Rita Blandino
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4 00165, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiovascular Imaging Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ilaria Cazzoli
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4 00165, Rome, Italy
| | - Cristina Raimondo
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4 00165, Rome, Italy
| | - Corrado Di Mambro
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4 00165, Rome, Italy
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Shen C, Jia Z, Yu Y, Feng M, Du X, Fu G, Yu L, Wu T, Jiang Y, Jin H, Zhuo W, Gao F, Wang B, Chen S, Dai J, Fang R, Chu H. Efficacy and safety of pulsed field ablation for accessory pathways: a pilot study. Europace 2024; 26:euae139. [PMID: 38801673 PMCID: PMC11218562 DOI: 10.1093/europace/euae139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/06/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024] Open
Abstract
AIMS Radiofrequency ablation is used as a first-line therapy for accessory pathways (APs). However, data regarding the effects of pulsed field ablation (PFA) on APs are limited. We sought to evaluate the acute procedural and 6-month success and safety of PFA in a cohort of patients with APs. METHODS AND RESULTS A focal contact force-sensing PFA catheter was used for patients with APs. Pulsed field ablation generator generated a bipolar and biphasic waveform (±1000 V) with a duration of 100 ms from the tip of the PFA catheter. A 100% acute procedural success was achieved in 10 conscious patients with APs (7 left anterolateral, 2 left inferolateral, and 1 right posteroseptal APs) including 6 (60%) patients after an initial application. The average total ablation time was 6.3 ± 4.9 s for 4.7 ± 1.8 ablation sites (ASs), including 3.1 ± 2.4 s at targets and 3.2 ± 2.9 s at 3.2 ± 2 bolus ASs. The mean skin-to-skin time was 59.3 ± 15.5 min, and PFA catheter dwell time was 29.4 ± 7.8 min. One patient encountered transient sinus arrest during PFA due to parasympathetic overexcitation. Sinus rhythm was restored in all patients without any significant adverse events during the short-term follow-up. CONCLUSION Pulsed field ablation of APs was feasible, effective, and safe. Its efficiency was remarkable for its ultrarapid termination of AP conduction. Further studies are warranted to prove whether utilization of PFA with current parameters can extend to manifold AP ablation.
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Affiliation(s)
- Caijie Shen
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Zhenyu Jia
- Health Science Center, Ningbo University, Ningbo 315000, China
| | - Yibo Yu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Mingjun Feng
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Xianfeng Du
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Guohua Fu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Lipu Yu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Tao Wu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Yongxing Jiang
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - He Jin
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Weidong Zhuo
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Fang Gao
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Binhao Wang
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Si Chen
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Jiating Dai
- Health Science Center, Ningbo University, Ningbo 315000, China
| | - Renyuan Fang
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
| | - Huimin Chu
- Cardiac Arrhythmia Center, The First Affiliated Hospital of Ningbo University, 59th Liuting Street, Haishu district, Ningbo 315000, China
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Kataoka N, Imamura T. Optimizing pediatric coronary sinus ablation: addressing feasibility, safety, and procedure selection concerns. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01736-8. [PMID: 38261101 DOI: 10.1007/s10840-024-01736-8] [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: 12/13/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Naoya Kataoka
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan
| | - Teruhiko Imamura
- Second Department of Internal Medicine, University of Toyama, 2630 Sugitani Toyama, Toyama, 930-0194, Japan.
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