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Garibaldi S, Chianca M, Fabiani I, Emdin M, Piacenti M, Passino C, Aimo A, Fedele A, Cipolla CM, Cardinale DM. Treatment Options in AF Patients with Cancer; Focus on Catheter Ablation. J Clin Med 2022; 11:jcm11154452. [PMID: 35956068 PMCID: PMC9369260 DOI: 10.3390/jcm11154452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/13/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Longer life expectancy along with advancements in cancer and atrial fibrillation (AF) therapies and treatment strategies have led to an increase in the number of individuals with both diseases. As a result, the complicated management of these patients has become crucial, necessitating individualised treatment that considers the bi-directional relationship between these two diseases. On the one hand, giving appropriate pharmaceutical therapy is exceptionally difficult, considering the recognised thromboembolic risk posed by AF and malignancy, as well as the haemorrhagic risk posed by cancer. The alternative pulmonary vein isolation (PVI) ablation, on the other hand, has been inadequately explored in the cancer patient population; there is yet inadequate data to allow the clinician to unambiguously select patients that can undertake this therapeutic intervention. The goal of this review is to compile the most valuable data and supporting evidence about the characteristics, care, and therapy of cancer patients with AF. Specifically, we will evaluate the pharmaceutical options for a proper anticoagulant therapy, as well as the feasibility and safety of PVI in this population.
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Affiliation(s)
- Silvia Garibaldi
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
| | - Michela Chianca
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Correspondence:
| | - Michele Emdin
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Marcello Piacenti
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
| | - Claudio Passino
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy; (S.G.); (M.E.); (M.P.); (C.P.)
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Alberto Aimo
- Health Science Interdisciplinary Center, Scuola Superiore Sant’Anna, 56127 Pisa, Italy; (M.C.); (A.A.)
| | - Antonella Fedele
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| | - Carlo Maria Cipolla
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
| | - Daniela Maria Cardinale
- Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, 20141 Milan, Italy; (A.F.); (C.M.C.); (D.M.C.)
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Ramos-Maqueda J, Álvarez M, Cabrera-Ramos M, Perin F, Rodríguez-Vázquez Del Rey MDM, Jiménez-Jaimez J, Macías-Ruiz R, Molina-Lerma M, Sánchez-Millán P, Tercedor-Sánchez L. Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:166-173. [PMID: 33741288 DOI: 10.1016/j.rec.2020.11.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. METHODS We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). RESULTS We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). CONCLUSIONS The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation.
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Affiliation(s)
- Javier Ramos-Maqueda
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Miguel Álvarez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Mercedes Cabrera-Ramos
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Francesca Perin
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Servicio de Pediatría, Hospital Materno Infantil Virgen de las Nieves, Granada, Spain
| | | | - Juan Jiménez-Jaimez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rosa Macías-Ruiz
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Manuel Molina-Lerma
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Sánchez-Millán
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Luis Tercedor-Sánchez
- Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Ramos-Maqueda J, Álvarez M, Cabrera-Ramos M, Perin F, Rodríguez-Vázquez del Rey MDM, Jiménez-Jaimez J, Macías-Ruiz R, Molina-Lerma M, Sánchez-Millán P, Tercedor-Sánchez L. Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2020.11.020] [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]
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Mahendran AK, Bussey S, Chang PM. Fluoroscopy-free ablation in congenital heart disease of moderate or great complexity. J Interv Card Electrophysiol 2021; 63:611-620. [PMID: 34694539 DOI: 10.1007/s10840-021-01079-8] [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: 07/01/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Fluoroscopy-free (FF) ablation has been demonstrated to be safe and successful in patients with structurally normal hearts, but has not been systematically evaluated in patients with congenital heart disease (CHD) of moderate or great (M/G) complexity. This study aimed to evaluate and compare feasibility, safety, and outcomes of FF ablation in patients with or without M/G-CHD. METHODS Consecutive patients undergoing electrophysiologic study and intended catheter ablation over a 24-month period were included. Subgroups were created based on presence and complexity of CHD-M/G-CHD or simple complexity/no CHD (S/N-CHD). Cases with total radiation dose of zero qualified as FF. Demographic and peri-procedural variables and outcome data were analyzed. RESULTS A total of 89 procedures were included with 62 comprising the S/N-CHD group and 27 comprising the M/G-CHD group. Of the M/G-CHD patients, 13 had CHD of great complexity (including 6 single ventricle/Fontan and 2 atrial switch patients). Patients with M/G-CHD were older, had higher BMI, had higher incidence of ventricular dysfunction, and greater incidence of complex arrhythmias. Fluoroscopy-free ablation was achieved in 59% of M/G-CHD and 69% of S/N-CHD patients. Both groups had similar rates of acute procedural success, recurrence, and complications. Fluoroscopy was primarily used to visualize pre-existing transvenous leads and peripheral venous anomalies or to guide transbaffle/transseptal puncture. CONCLUSIONS A fluoroscopy-free ablation approach is feasible, safe, and successful even in patients with M/G-CHD with comparable outcomes to those with S/N-CHD.
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Affiliation(s)
- Arjun K Mahendran
- Congenital Heart Center, University of Florida, 1600 SW Archer Rd, P.O. Box 100296, Gainesville, FL, 32610, USA.
| | - Sara Bussey
- Congenital Heart Center, University of Florida, 1600 SW Archer Rd, P.O. Box 100296, Gainesville, FL, 32610, USA
| | - Philip M Chang
- Congenital Heart Center, University of Florida, 1600 SW Archer Rd, P.O. Box 100296, Gainesville, FL, 32610, USA
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Jan M, Žižek D, Prolič Kalinšek T, Kuhelj D, Trunk P, Kolar T, Kšela J, Rauber M, Yazici M. Minimising radiation exposure in catheter ablation of ventricular arrhythmias. BMC Cardiovasc Disord 2021; 21:306. [PMID: 34134637 PMCID: PMC8210369 DOI: 10.1186/s12872-021-02120-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/10/2021] [Indexed: 12/05/2022] Open
Abstract
Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD).
Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.
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Affiliation(s)
- Matevž Jan
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - David Žižek
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tine Prolič Kalinšek
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Dimitrij Kuhelj
- Clinical Institute for Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Primož Trunk
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Tadeja Kolar
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Juš Kšela
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
| | - Martin Rauber
- Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mehmet Yazici
- Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia
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Catheter ablation of focal atrial tachycardia in children using three-dimensional electroanatomic mapping system: a 6-year single-centre experience. Cardiol Young 2021; 31:744-750. [PMID: 33308335 DOI: 10.1017/s1047951120004527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study demonstrates the clinical and electrophysiological details of catheter ablation conducted in children with focal atrial tachycardia using three-dimensional electroanatomic mapping systems. PATIENTS AND METHODS Electrophysiological procedures were performed using the EnSite™ system. RESULTS Between 2014 and 2020, 60 children (median age 12.01 years [16 days-18 years]; median weight 41.5 kg [3-98 kg]) with focal atrial tachycardia and treated with catheter ablation were evaluated retrospectively. Tachycardia-induced cardiomyopathy was developed in 15 patients (25%). Most of the focal atrial tachycardia foci were right-sided (75%), and more than one focus was found in four patients. Radiofrequency ablation was performed in 47 patients (irrigated radiofrequency ablation in seven cases), cryoablation in 9, and radiofrequency ablation and cryoablation in the same session in 4 patients. The median procedural time was 163.5 minutes (82-473 minutes). Fluoroscopy was used in 29 of (48.3%) patients (especially for left-side substrate) with a mean time of 8.6 ± 6.2 minutes. The acute success rate was 95%. The procedure failed in three patients, and recurrence was observed in 3.5% of patients (2/57) during a median follow-up of 17 months (2-69 months). The second ablation was performed in four cases, of which three were successful. Overall success rate was 96.6% with no major complications observed, except in one patient with minimal pericardial effusion. CONCLUSION Catheter ablation seems to be an effective and safe treatment in focal atrial tachycardia. Electroanatomic mapping system can facilitate the ablation procedure and minimise radiation exposure.
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Assessment of a novel radiation reduction protocol for pediatric and adult congenital device implantation. J Interv Card Electrophysiol 2018; 55:93-98. [PMID: 30413993 DOI: 10.1007/s10840-018-0479-z] [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: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Device implantation requires fluoroscopic guidance, which carries inherent risks of ionizing radiation. We evaluated the impact of a low-dose fluoroscopic protocol on radiation exposure during device implantation. METHODS All patients who underwent pacemaker or ICD implantation with new transvenous leads from July 2011 to January 2018 were included. A novel ALARA protocol consisting of ultra-low frame rates (2-3 frames/s), low dose/frame (6-18 mGy/frame), and use of the "air-gap" technique in patients < 20 kg was employed. Demographics, procedural data, and radiation exposure levels were collected and analyzed. RESULTS Thirty patients underwent device implantation without additional catheterization, electrophysiology study, or ablation procedure (median age 15 years; range 5-50) with a total of 43 leads placed. Forty-seven percent of patients had a primary rhythm disturbance, 33% had cardiomyopathy, and 20% had congenital heart disease. Fifty percent were pacemakers (53% dual-chamber, 27% ventricle, 20% atrial) and 50% of devices implanted were ICDs (87% single-chamber). All implants were acutely successful with acceptable atrial and ventricular sensing and capture thresholds. The median fluoroscopy time was 11.5 min (inter-quartile range (IQR) 8.0-18.2), median air kerma dose 4.0 mGy (IQR 2.5-19.5), and median dose-area product 27.8 μGy/m2 (IQR 17.1-106.5). Median implant procedure time was 133 min. One patient required revision secondary to device migration without lead derangement 2 days post-procedure. CONCLUSIONS Use of a novel fluoroscopic protocol may help decrease radiation exposure to patients and staff without affecting efficacy or risk. These data may represent benchmarks against which future device implantation procedures can be compared.
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Electroanatomic Mapping-Guided Catheter Ablation of Supraventricular Tachycardia in Children with Ebstein's Anomaly. Pediatr Cardiol 2018; 39:1445-1452. [PMID: 29882187 DOI: 10.1007/s00246-018-1915-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
In Ebstein's anomaly (EA), tachycardia substrates are complex, and accessory pathway (AP) ablations are often challenging. This study demonstrates the utility of the EnSite Velocity system (St. Jude Medical, St Paul, MN) in the catheter ablation of supraventricular tachycardia in children with EA. Twenty patients [Female/Male = 8/12, median age 11.5 years (2.6-18)] with EA who underwent catheter ablation guided by the EnSite Velocity system between December 2011 and December 2016 were retrospectively evaluated. Five patients had severe EA, and two of them were at Fontan palliation pathway. The most common indications for ablations were palpitations/syncope and treatment-resistant arrhythmias. Thirty-one tachycardia substrate foci (21 manifest AP, 2 concealed AP, 4 Mahaim AP, 3 focal atrial tachycardias, and 1 typical atrioventricular nodal reentrant tachycardia) were detected in 20 patients. There were multiple tachycardia substrates in 11 patients (55%). The patient-based acute procedure success rate was 19/20 (95%), and the tachycardia-based success rate was 30/31 (97%). The mean procedure time was 170 ± 43 min (90-265). Fluoroscopy was not used in 15 (75%) patients. The mean fluoroscopy time in the remaining five patients was 3.6 ± 2.9 min (0.7-7.8). During a mean follow-up of 35.1 ± 20.3 months (6-60), tachycardia recurred in four patients (4/19, 21%). No complications were seen. Catheter ablation of arrhythmias can be performed effectively and safely in pediatric EA patients by using a limited fluoroscopic approach with the help of electroanatomical mapping systems. However, the rate of tachycardia recurrence at follow-up remains high.
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Long-term outcomes after “Zero X-ray” arrhythmia ablation. J Interv Card Electrophysiol 2018; 54:43-48. [DOI: 10.1007/s10840-018-0390-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
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Casella M, Dello Russo A, Russo E, Catto V, Pizzamiglio F, Zucchetti M, Majocchi B, Riva S, Vettor G, Dessanai MA, Fassini G, Moltrasio M, Tundo F, Vignati C, Conti S, Bonomi A, Carbucicchio C, Di Biase L, Natale A, Tondo C. X-Ray Exposure in Cardiac Electrophysiology: A Retrospective Analysis in 8150 Patients Over 7 Years of Activity in a Modern, Large-Volume Laboratory. J Am Heart Assoc 2018; 7:JAHA.117.008233. [PMID: 29789334 PMCID: PMC6015357 DOI: 10.1161/jaha.117.008233] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Only a few studies have systematically evaluated fluoroscopy data of electrophysiological and device implantation procedures. Aims of this study were to quantify ionizing radiation exposure for electrophysiological/device implantation procedures in a large series of patients and to analyze the x‐ray exposure trend over years and radiation exposure in patients undergoing atrial fibrillation ablation considering different technical aspects. Methods and Results We performed a retrospective analysis of all electrophysiological/device implantation procedures performed during the past 7 years in a modern, large‐volume laboratory. We reported complete fluoroscopy data on 8150 electrophysiological/device implantation procedures (6095 electrophysiological and 2055 device implantation procedures); for each type of procedure, effective dose and lifetime attributable risk of cancer incidence and mortality were calculated. Over the 7‐year period, we observed a significant trend reduction in fluoroscopy time, dose area product, and effective dose for all electrophysiological procedures (P<0.001) and a not statistically significant trend reduction for device implantation procedures. Analyzing 2416 atrial fibrillation ablations, we observed a significant variability of fluoroscopy time, dose area product and effective dose among 7 different experienced operators (P<0.0001) and a significant reduction of fluoroscopy use over time (P<0.0001) for all of them. Considering atrial fibrillation ablation techniques, fluoroscopy time was not different (P = 0.74) for radiofrequency catheter ablation in comparison with cryoablation, though cryoablation was still associated with higher dose area product and effective dose values (P<0.001). Conclusions Electrophysiological procedures involve a nonnegligible x‐ray use, leading to an increased risk of malignancy. Awareness of radiation‐related risk, together with technological advances, can successfully optimize fluoroscopy use.
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Affiliation(s)
- Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Eleonora Russo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Catto
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Martina Zucchetti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Stefania Riva
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulia Vettor
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Gaetano Fassini
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Massimo Moltrasio
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Carlo Vignati
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Sergio Conti
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Alice Bonomi
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore Hospital, Bronx, NY.,Texas Cardiac Arrhythmia Institute, St Davis Medical Center, Austin, TX.,Department of Biomedical Engineering, University of Texas at Austin, TX.,Department of Cardiology, University of Foggia, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St Davis Medical Center, Austin, TX.,Department of Biomedical Engineering, University of Texas at Austin, TX.,Dell Medical School, University of Texas at Austin, TX.,California Pacific Medical Center, San Francisco, CA
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Italy
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Swissa M, Birk E, Dagan T, Naimer SA, Fogelman M, Einbinder T, Bruckheimer E, Fogelman R. Radiofrequency catheter ablation of atrioventricular node reentrant tachycardia in children with limited fluoroscopy. Int J Cardiol 2017; 236:198-202. [PMID: 28202257 DOI: 10.1016/j.ijcard.2017.01.128] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/04/2017] [Accepted: 01/26/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited fluoroscopy cryo-ablation using a 3D electro-anatomical system (3DS) has been used for AVNRT in children. We aimed to facilitate a fluoroscopy limited approach of RF ablation of AVNRT in children. METHODS A retrospective study was performed of procedure parameters in children undergoing RF ablation of AVNRT in 75 consecutive children (June 2011 to November 2013 - Group A) using standard fluoroscopy techniques compared to those of 64 consecutive children (December 2013 to May 2015 - Group B), using a fluoroscopy limited approach with 3DS. RESULTS The acute success rate was 98.7% (74/75) and 98.4% (63/64) for groups A and B, respectively. The recurrence rate was 2.7% (2/74) and 0% (0/63) with a mean follow-up period of 45.5±12.1 and 14.3±6.1months for group A and group B, respectively. The mean procedure and fluoroscopy times were significantly lower for group B compared to group A (119±37 (43-203) and 0.83±1.04 (0.05-3.83) minutes versus 146±53 (72-250) and 16.1±8.9 (4.39-55) minutes, p<0.003 and p<0.0001, respectively). There were no ablation-related complications. CONCLUSIONS A fluoroscopy limited approach for RF ablation of AVNRT in children using a 3DS is easily acquired and adapted, and significantly reduces the fluoroscopy and procedure time with excellent efficacy, safety and low recurrence rate. CONDENSED ABSTRACT This study confirmed that a 3D mapping system (3DS) to guide ablations of AVNRT in children reduces radiation exposure. Combined, limited fluoroscopy and 3DS in a methodology that resembles the familiar conventional fluoroscopy approach for RF ablation of AVNRT in children is proposed. Combined limited fluoroscopy and RF-energy in children with AVNRT are associated with a shorter procedure time, minimal fluoroscopy time, a high success rate and a low recurrence rate.
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Affiliation(s)
- Moshe Swissa
- Kaplan Medical Center, Rehovot, Israel; The Hebrew University, Jerusalem, Israel.
| | - Einat Birk
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Tamir Dagan
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Sody Abby Naimer
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Fogelman
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Tom Einbinder
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Elchanan Bruckheimer
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Fogelman
- Schneider Children's Medical Center Israel, Petach Tikva, and Sackler School of Medicine, Tel Aviv University, Israel
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Swissa M, Birk E, Dagan T, Abby Naimer S, Fogelman M, Einbinder T, Bruckheimer E, Fogelman R. Limited fluoroscopy catheter ablation of accessory pathways in children. J Cardiol 2017; 70:382-386. [PMID: 28274505 DOI: 10.1016/j.jjcc.2016.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/20/2016] [Accepted: 12/28/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children. METHODS Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30° and left anterior oblique-60° views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8±4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP). RESULTS The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean follow-up of 13±5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144±45 (55-262)min and 1.8±1.4 (0.1-5.6)min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171±53min vs 135±38min, p<0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications. CONCLUSIONS A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.
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Affiliation(s)
- Moshe Swissa
- Kaplan Medical Center, Rehovot, The Hebrew University, Jerusalem, Israel.
| | - Einat Birk
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Tamir Dagan
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Sody Abby Naimer
- Department of Family Medicine, Siaal Family Medicine and Primary Care Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Fogelman
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Tom Einbinder
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Elchanan Bruckheimer
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
| | - Rami Fogelman
- The Schneider Children's Medical Center of Israel, Cardiology Institute, Petach Tiqva, Sackler School of Medicine, Tel Aviv University, Israel
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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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McCauley MD, Patel N, Greenberg SJ, Molina-Razavi JE, Safavi-Naeini P, Razavi M. Fluoroscopy-free Atrial Transseptal Puncture. ACTA ACUST UNITED AC 2016; 2:57-61. [PMID: 29862050 DOI: 10.17925/ejae.2016.02.02.57] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction Fluoroscopy is traditionally used in atrial transseptal puncture (TSP); however fluoroscopy exposes patient and physician to excess radiation. Here, we describe a feasibility study of a zero-fluoroscopy transseptal puncture (ZFTSP) technique utilising electroanatomical mapping (EAM) and intracardiac echo (ICE) in a small case series of patients undergoing ablation for atrial fibrillation (AF). We then compare this technique to other established ZFTSP techniques for paroxysmal AF ablation. Methods Seven patients received ZFTSP. An Acunav™ ICE catheter (Biosense Webster Inc., California, US) was placed in the right atrium, then an Agilis™ sheath (St. Jude Medical, Saint Paul, Minnesota, US) was established into the inferior vena cava. A ThermoCool® SmartTouch™ catheter (Biosense Webster Inc., California, US) was inserted through the Agilis to map the fossa ovalis. Mapping catheter exchange for dilator and needle allowed for facile ZFTSP. AF outcome, fluoroscopy times, and procedure times were compared with eight age-matched control patients. Results There were no significant differences in age, body mass index (BMI) or AF duration between the two groups and no immediate complications. ZFTSP procedure time was 183.9±33.7 minutes versus 293.13±129.9 minutes for TSP-only controls (p=0.05). Fluoroscopy time was 17.5±14.1 minutes in ZFTSP patients versus 73.4±50.3 minutes in controls (p=0.01). AF recurrence in ZFTSP patients was 14% versus 25% in controls. Conclusion ZFTSP utilising ICE and EAM is safe, effective, and time-efficient. There is a small but significant reduction in radiation exposure to patient and physician by the use of this technique.
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Affiliation(s)
- Mark D McCauley
- Department of Medicine, Section of Cardiology, The University of Illinois at Chicago and the Jesse Brown VA Medical Center, Chicago, Illinois, US
| | - Nisarg Patel
- The Wright Center, Wilkes-Barre, Pennsylvania, US
| | - Scott J Greenberg
- The Texas Heart Institute and Baylor College of Medicine, Houston, Texas, US
| | | | - Payam Safavi-Naeini
- The Texas Heart Institute and Baylor College of Medicine, Houston, Texas, US
| | - Mehdi Razavi
- The Texas Heart Institute and Baylor College of Medicine, Houston, Texas, US
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15
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Thomas PE, Macicek SL. Catheter Ablation to Treat Supraventricular Arrhythmia in Children and Adults With Congenital Heart Disease: What We Know and Where We Are Going. Ochsner J 2016; 16:290-6. [PMID: 27660579 PMCID: PMC5024812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Catheter ablation has been used to manage supraventricular arrhythmia in children since 1990. This article reviews the history of catheter ablation used to treat arrhythmia in children and discusses new frontiers in the field. We also address ablation in adult patients with a history of congenital heart disease (CHD) that was diagnosed and initially treated in childhood. METHODS We conducted an evidence-based literature review to gather available data on ablation for supraventricular tachycardia in children and adult patients with CHD. RESULTS Ablations can be performed safely and effectively in children. Complication rates are higher in children <4 years and <15 kg. In one study, the overall success rate of radiofrequency ablation in pediatrics was 95.7%, with the highest success rate in left free wall pathways (97.8%). Recurrence was higher in septal pathways. Cryoablation has been reported to have a 93% acute success rate for atrioventricular (AV) nodal reentrant tachycardia and septal pathways with no risk of AV block and a 5%-9% risk of recurrence. Three-dimensional mapping, intracardiac echocardiography, remote magnetic navigation, and irrigated catheter ablation are new technologies used to treat pediatric and adult patients with CHD. The population of adult patients with CHD is growing, and these patients are at particularly high risk for arrhythmia. A paucity of data is available on ablation in adult patients with CHD. CONCLUSION Electrophysiology for pediatric and adult patients with CHD is a rapidly growing and progressing field. We benefit from continuous development of ablation techniques for adults with structurally normal hearts and have the unique challenge and responsibility to ensure the safe and effective application of these techniques in the vulnerable population of pediatric and adult patients with CHD.
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Affiliation(s)
- Patricia E. Thomas
- Department of Pediatric Cardiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Scott L. Macicek
- Department of Pediatric Cardiology, Ochsner Clinic Foundation, New Orleans, LA
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16
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Efficacy and safety of zero-fluoroscopy ablation for supraventricular tachycardias. Herz 2015; 41:241-5. [DOI: 10.1007/s00059-015-4358-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 07/29/2015] [Accepted: 09/11/2015] [Indexed: 11/27/2022]
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Catheter ablation of idiopathic ventricular tachycardia without the use of fluoroscopy. Int J Cardiol 2015; 190:338-43. [PMID: 25935624 DOI: 10.1016/j.ijcard.2015.04.146] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/17/2015] [Accepted: 04/16/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Catheter ablation is the treatment of choice for many patients with idiopathic ventricular tachycardia (VT). Unfortunately, conventional catheter ablation is guided by fluoroscopy, which is associated with a small but definite radiation risk for patients and laboratory personnel. The aim of our study is to assess feasibility, success rate and safety of idiopathic VT ablation procedure performed without the use of fluoroscopy. METHODS Nineteen consecutive patients undergoing idiopathic VT ablation at our institution have been included. The ablation procedures were performed under the guidance of electroanatomical mapping (EAM) system and intracardiac echocardiography (ICE). RESULTS Nineteen patients (mean age 38.7 years) underwent ablation procedure for idiopathic VT. Twelve (63%) had outflow tract VT, 3 (18%) fascicular tachycardia, 2 (11%) peri-tricuspidal VT, 1 (5%) peri-mitral VT, and 1 (5%) lateral left free-wall VT. The mean procedural time was 170.2 ± 45.7 min. No fluoroscopy was used in any procedural phase. Acute success rate was 100%. No complication was documented in any patients. After a mean follow up of 18 ± 4 months, recurrences occurred in 2 patients. CONCLUSIONS In our preliminary experience idiopathic VT ablation without the use of fluoroscopy was feasible and safe, using a combination of EAM and ICE. Success rate was excellent with no complication.
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Abstract
Since the introduction of transcatheter ablation in the late 1980s, there has been significant technical development. With a very high success rate and low complication rate, ablation has now become the standard of care in children and adults. However, long-term data remain insufficient and the application of ablation therapy in small children is debatable. In this review, current treatment strategies and results in toddlers and infants will be discussed. There has been improvement in success rate and complication rate for ablation in small children. Technological advancements in non-fluoroscopic electroanatomical mapping systems (3D systems) have led to the reduction of radiation and have facilitated ablations in complex cases. However, long-term effects of ablation lesions in small children remain a potential concern.
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Affiliation(s)
- Hiroko Asakai
- Labatt Family Heart Centre and Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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19
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Haas NA, Happel CM, Mauti M, Sahyoun C, Tebart LZ, Kececioglu D, Laser KT. Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology. IJC HEART & VASCULATURE 2015; 6:101-109. [PMID: 28785634 PMCID: PMC5497176 DOI: 10.1016/j.ijcha.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/10/2015] [Accepted: 01/13/2015] [Indexed: 11/25/2022]
Abstract
Background Pediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent years. This study aims at quantifying the patient radiation dose reduction after the introduction of an X-ray imaging technology using advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure in a pediatric and adult population with congenital heart disease. Methods Patient and radiation dose data was retrospectively collected (July 2012–February 2013) for 338 consecutive patients treated with a system using state of the art image processing and reference acquisition chain (referred as “reference system”). The same data was collected (March–October 2013) for 329 consecutive patients treated with the new imaging technology (Philips AlluraClarity, referred as “new system”). Patients were divided into three weight groups: A) below 10 kg, B) 10–40 kg, and C) over 40 kg. Radiation dose was quantified using dose area product (DAP), while procedure complexity using fluoroscopy time, procedure duration and volume of contrast medium. Results The new system provides significant patient dose reduction compared to the reference system. Median DAP values were reduced in group A) from 140.6 cGy·cm2 to 60.7 cGy·cm2, in group B) from 700.0 cGy·cm2 to 202.2 cGy·cm2 and in group C) from 4490.4 cGy·cm2 to 1979.8 cGy·cm2 with reduction of 57%, 71% and 56% respectively (p < 0.0001 for all groups). Conclusions Despite no other changes in procedural approach, the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher. x-ray radiation dose in pediatric patients is of specific concern as congenital heart disease is more often treated by interventional measures. the effect of advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure was studied. A state of the art image processing and reference acquisition chain was compared to the new imaging technology in 338 vs 329 consecutive patients. Patients were divided into three weight groups: A) below 10 kg, B) 10-40 kg, and C) over 40 kg according to clinical practice and procedure complexity. the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher.
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Affiliation(s)
- Nikolaus A Haas
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Christoph M Happel
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | | | | | - Lea Z Tebart
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Deniz Kececioglu
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
| | - Kai Thorsten Laser
- Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia, Ruhr University Bochum, Germany
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Radiation safety protocol using real-time dose reporting reduces patient exposure in pediatric electrophysiology procedures. Pediatr Cardiol 2014; 35:1116-23. [PMID: 24801673 DOI: 10.1007/s00246-014-0904-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/25/2014] [Indexed: 12/21/2022]
Abstract
Radiation exposure during pediatric catheterization is significant. We sought to describe radiation exposure and the effectiveness of radiation safety protocols in reducing exposure during catheter ablations with electrophysiology studies in children and patients with congenital heart disease. We additionally sought to identify at-risk patients. We retrospectively reviewed all interventional electrophysiology procedures performed from April 2009 to September 2011 (6 months preceding intervention, 12 months following implementation of initial radiation safety protocol, and 8 months following implementation of modified protocol). The protocols consisted of low pulse rate fluoroscopy settings, operator notification of skin entrance dose every 1,000 mGy, adjusting cameras by >5 at every 1,000 mGy, and appropriate collimation. The cohort consisted of 291 patients (70 pre-intervention, 137 after initial protocol implementation, 84 after modified protocol implementation) at a median age of 14.9 years with congenital heart disease present in 11 %. Diagnoses included atrioventricular nodal reentrant tachycardia (25 %), atrioventricular reentrant tachycardia (61 %), atrial tachycardias (12 %), and ventricular tachycardia (2 %). There were no differences between groups based on patient, arrhythmia, and procedural characteristics. Following implementation of the protocols, there were significant reductions in all measures of radiation exposure: fluoroscopy time (17.8 %), dose area product (80.2 %), skin entry dose (81.0 %), and effective dose (76.9 %), p = 0.0001. Independent predictors of increased radiation exposure included larger patient weight, longer fluoroscopy time, and lack of radiation safety protocol. Implementation of a radiation safety protocol for pediatric and congenital catheter ablations can drastically reduce radiation exposure to patients without affecting procedural success.
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Catheter ablation of idiopathic ventricular tachycardia in children using the EnSite NavX system with/without fluoroscopy. Cardiol Young 2014; 24:886-92. [PMID: 24018141 DOI: 10.1017/s1047951113001364] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Curative therapy of idiopathic ventricular tachycardia remains a challenge in interventional electrophysiology. The aim of this study was to demonstrate the utility of an EnSite NavX system in the catheter ablation of idiopathic ventricular tachycardia in children. PATIENTS AND METHODS In all, 17 children with idiopathic ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. RESULTS The mean patient age was 13 ± 2.4 years (range: 7.8-17.9) and the mean patient weight was 52.3 ± 11.9 kg (range: 32-75). The origin of ventricular tachycardia was in the right ventricular outflow tract in nine patients, in the left ventricle in six, near the bundle of His/right bundle branch in one, and in the left aortic cusp in one. The mean procedure and fluoroscopy times were 169.3 ± 43.2 minutes and 8 ± 10.8 minutes, respectively. No fluoroscopy was used in six patients. The mean radiation exposure was 33.1 ± 56.4 mGy. Acute success was achieved in 14 patients (82%). The focus of ventricular tachycardia was epicardial in two failed procedures. During a mean follow-up of 8.5 ± 7.6 months, ventricular tachycardia recurred in three patients, two of whom underwent a second procedure. Except for one patient who developed transient right bundle branch block, no complications were seen. CONCLUSION Catheter ablation of idiopathic ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using the EnSite NavX system.
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Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, Papez A, Phillips JR, Rhodes LA, Saul P, Stephenson E, Stevenson W, Zimmerman F. PACES/HRS expert consensus statement on the evaluation and management of ventricular arrhythmias in the child with a structurally normal heart. Heart Rhythm 2014; 11:e55-78. [PMID: 24814375 DOI: 10.1016/j.hrthm.2014.05.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Indexed: 01/02/2023]
Affiliation(s)
- Jane E Crosson
- Bloomberg Children's Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David J Callans
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Anne Dubin
- Lucile Packard Children's Hospital, Stanford School of Medicine, Stanford, California
| | | | - Susan Etheridge
- University of Utah and Primary Children's Medical Center, Salt Lake City, Utah
| | - Andrew Papez
- Phoenix Children's Hospital/Arizona Pediatric Cardiology Consultants Phoenix, Arizona
| | | | | | - Philip Saul
- Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | | | - William Stevenson
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank Zimmerman
- Advocate Heart Institute for Children Advocate Children's Hospital, Oak Lawn, Illinois.
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Pflaumer A. Perspectives in ablation of arrhythmias in children and patients with congenital heart disease. Intern Med J 2012; 42 Suppl 5:70-6. [PMID: 23035686 DOI: 10.1111/j.1445-5994.2012.02899.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although most arrhythmias in children have a benign outcome, recurrent arrhythmic events have a significant impact on quality of life. Electrophysiology studies with ablation have good short-term success and an acceptably low complication rate. The long-term outlook for this patient group is incompletely defined, however. Factors that require special consideration in children include the need to limit the size, depth and number of lesions, and the radiation exposure incurred during fluoroscopy-guided catheters manipulation. The use of cryoablation seems promising in limiting lesion size. Three-dimensional (3D) mapping systems clearly have been shown to reduce the radiation dose. In congenital heart disease, these advances in technology have helped to further our understanding of the mechanisms underlying arrhythmias. It is anticipated that earlier intervention and newer operative techniques will reduce the incidence of postoperative arrhythmias in the future. For those patients who still develop tachyarrythmias after cardiac surgery, the use of three-dimensional systems and other new technologies permits more efficient intervention in the electrophysiology laboratory.
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Affiliation(s)
- Andreas Pflaumer
- Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
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24
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Vasilyev NV, Dupont PE, del Nido PJ. Robotics and imaging in congenital heart surgery. Future Cardiol 2012; 8:285-96. [PMID: 22413986 DOI: 10.2217/fca.12.20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The initial success seen in adult cardiac surgery with the application of available robotic systems has not been realized as broadly in pediatric cardiac surgery. The main obstacles include extended set-up time and complexity of the procedures, as well as the large size of the instruments with respect to the size of the child. Moreover, while the main advantage of robotic systems is the ability to minimize incision size, for intracardiac repairs, cardiopulmonary bypass is still required. Catheter-based interventions, on the other hand, have expanded rapidly in both application as well as the complexity of procedures and lesions being treated. However, despite the development of sophisticated devices, robotic systems to aid catheter procedures have not been commonly applied in children. In this article, we describe new catheter-like robotic delivery platforms, which facilitate safe navigation and enable complex repairs, such as tissue approximation and fixation, and tissue removal, inside the beating heart. Additional features including the tracking of rapidly moving tissue targets and novel imaging approaches are described, along with a discussion of future prospects for steerable robotic systems.
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Pflaumer A, Chard R, Davis AM. Perspectives in Interventional Electrophysiology in Children and those with Congenital Heart Disease. Heart Lung Circ 2012; 21:413-20. [DOI: 10.1016/j.hlc.2012.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Revised: 04/02/2012] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
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RAZMINIA MANSOUR, MANANKIL MARIANF, ERYAZICI PAULAL, ARRIETA-GARCIA CARLOS, WANG THEODORE, D'SILVA OLIVERJ, LOPEZ CHRISTIANS, CRYSTAL GEORGEJ, KHAN SABA, STANCU MIHAELAM, TURNER MARIANNE, ANTHONY JOSEPH, ZHEUTLIN TERRYA, KEHOE RICHARDF. Nonfluoroscopic Catheter Ablation of Cardiac Arrhythmias in Adults: Feasibility, Safety, and Efficacy. J Cardiovasc Electrophysiol 2012; 23:1078-86. [DOI: 10.1111/j.1540-8167.2012.02344.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Houmsse M, Daoud EG. Radiation exposure: A silent complication of catheter ablation procedures. Heart Rhythm 2012; 9:715-6. [DOI: 10.1016/j.hrthm.2012.01.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Indexed: 11/26/2022]
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Kerst G, Weig HJ, Weretka S, Seizer P, Hofbeck M, Gawaz M, Schreieck J. Contact force-controlled zero-fluoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates. Heart Rhythm 2012; 9:709-14. [PMID: 22222276 DOI: 10.1016/j.hrthm.2011.12.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Indexed: 12/29/2022]
Abstract
BACKGROUND Conventional catheter ablation of cardiac arrhythmias is associated with radiation risks for patients and laboratory personnel. However, nonfluoroscopic catheter guidance may increase the risk for inadvertent cardiac injury. A novel radiofrequency ablation catheter capable of real-time tissue-tip contact force measurements may compensate for nonfluoroscopic safety issues. OBJECTIVE To investigate the feasibility of contact force-controlled zero-fluoroscopy catheter ablation. METHODS In 30 patients (including 12 pediatric patients), zero-fluoroscopy catheter ablation of right-sided (right atrium, n = 20; right ventricle, n = 2) and left atrial (n = 8) arrhythmias was attempted. Inclusion criteria were symptomatic suspected atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal right atrial and ventricular arrhythmias, and lone atrial fibrillation. A novel irrigated-tip catheter with an integrated contact force sensor was used for nonfluoroscopic 3-dimensional electroanatomical mapping and radiofrequency ablation. Transseptal access was gained under transesophageal guidance for ablation of left-sided arrhythmias. RESULTS Procedural success without fluoroscopy was achieved in 29 of the 30 patients (97%). In 1 patient, endocardial nonfluoroscopic ablation failed because of an epicardial accessory pathway within a coronary sinus aneurysm. Mean total contact force and amplitude of force undulations were kept below 50 g during mapping and below 40 g during ablation to prevent contact force peaks (>100 g). Apart from a transient second-degree type I atrioventricular block, no complications occurred. The mean procedure time was 2.8 ± 0.9 hours. There were no arrhythmia recurrences during a mean follow-up of 6.2 ± 4.2 months. CONCLUSION Contact force-controlled zero-fluoroscopy catheter ablation is generally feasible in right-sided and left atrial cardiac arrhythmias.
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Affiliation(s)
- Gunter Kerst
- Eberhard-Karls-Universität Tübingen, Tübingen, Germany.
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PAPAGIANNIS JOHN, AVRAMIDIS DIMOSTHENIS, ALEXOPOULOS CHRYSANTHOS, KIRVASSILIS GEORGE. Radiofrequency Ablation of Accessory Pathways in Children and Congenital Heart Disease Patients: Impact of a Nonfluoroscopic Navigation System. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1288-396. [DOI: 10.1111/j.1540-8159.2011.03170.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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