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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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Drago F, Calvieri C, Russo MS, Remoli R, Pazzano V, Battipaglia I, Gimigliano F, Allegretti G, Silvetti MS. Low-voltage bridge strategy to guide cryoablation of typical and atypical atrioventricular nodal re-entry tachycardia in children: mid-term outcomes in a large cohort of patients. Europace 2021; 23:271-277. [PMID: 33038208 DOI: 10.1093/europace/euaa195] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS In the current literature, results of the low-voltage bridge (LVB) ablation strategy for the definitive treatment of atrioventricular nodal re-entry tachycardia (AVNRT) seem to be encouraging also in children. The aims of this study were (i) to prospectively evaluate the mid-term efficacy of LVB ablation in a very large cohort of children with AVNRT, and (ii) to identify electrophysiological factors associated with recurrence. METHODS AND RESULTS One hundred and eighty-four children (42% male, mean age 13 ± 4 years) with AVNRT underwent transcatheter cryoablation guided by voltage mapping of the Koch's triangle. Acute procedural success was 99.2% in children showing AVNRT inducibility at the electrophysiological study. The overall recurrence rate was 2.7%. The presence of two LVBs, a longer fluoroscopy time and the presence of both typical and atypical AVNRT, were found to be significantly associated with an increased recurrence rate during mid-term follow-up. Conversely, there was no significant association between recurrences and patient's age, type of LVB, lesion length, number of cryolesions or catheter tip size. CONCLUSION The LVB ablation strategy is very effective in AVNRT treatment in children. Recurrences are related to the complexity of the arrhythmogenic substrate.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Camilla Calvieri
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Mario Salvatore Russo
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Romolo Remoli
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Vincenzo Pazzano
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Fabrizio Gimigliano
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | | | - Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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Persistence of Palpitations After Slow Pathway Modification for AVNRT in Young People. Pediatr Cardiol 2021; 42:590-596. [PMID: 33394109 PMCID: PMC8479320 DOI: 10.1007/s00246-020-02519-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Symptoms are the most common indication for ablation in children with atrioventricular nodal reentrant tachycardia (AVNRT). After the procedure, patients may continue to report palpitations. The objective of this study was to quantify the risk and duration of palpitations after pediatric slow pathway modification as well as demographic and technical associations. This was a retrospective review of consecutive patients at a pediatric center who underwent slow pathway modification for AVNRT from 2012 to 2018. Patients with a prior ablation attempt or congenital heart disease were excluded. Palpitations were documented in 35% of patients after ablation. Neither post-ablation echo beats nor other evidence of residual dual AV nodal physiology were associated with a higher risk of post-ablation palpitations. Of the 35 patients with post-ablation palpitations, the median time to resolution of palpitations was 48 months. Acute procedural success was achieved in all 100 cases. There were two recurrences of AVNRT during long-term follow-up and one instance of ectopic atrial tachycardia (3% SVT recurrence). Palpitations after AVNRT ablation occurred in approximately one-third of cases, despite a low recurrence of true arrhythmia. Prior to ablation, patients and families should be counseled that post-ablation palpitations are common and AVNRT recurrence is rare.
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Long-Term Patient Experience Following Acutely Successful Ablation of Supraventricular Tachycardia Substrate in Children. Pediatr Cardiol 2021; 42:109-115. [PMID: 32979068 DOI: 10.1007/s00246-020-02459-z] [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] [Received: 01/08/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Definitive treatment of supraventricular tachycardia (SVT) substrate involves catheter ablation. While objective success rates have been well established, long-term subjective patient experiences have not been well described. We quantify a subjective cure rate and characterize long-term patient experience after acutely successful ablation. A cross-sectional survey of pediatric patients with accessory pathways or atrioventricular nodal reentrant tachycardia who underwent acutely successful ablation from 2008 to 2012 was performed. Data were obtained from medical records and patient surveys. Patients with congenital heart disease other than patent ductus arteriosus, patent foramen ovale, or coronary artery abnormalities were excluded. Statistical analyses included Student's t-test and χ2 analysis for continuous and categorical variables, respectively. Surveys were sent to 153 patients of which 147 responded with median follow-up of 7.2 (IQR 6.1-8.5) years. Of the 147 responders, 124 (84%) patients reported cure with a male predominance. Symptoms were present in 130/147 (88%) patients pre-ablation and in 53/147 (36%) post-ablation. Among those with post-ablation symptoms, 50/53 (94%) reported symptomatic improvement. Recurrence occurred in 23/147 (16%) patients and was more prevalent following cryoablation. Ablation of SVT substrate can be curative with excellent long-term results and patient satisfaction. Long-term subjective cure rate is high and there is a substantial decrease in symptoms post-ablation. Many patients continue to have symptoms following ablation; however, the majority of these patients consider themselves cured and symptoms can be attributed to other etiologies. Recurrence is uncommon and occurs more frequently following cryoablation.
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Kafalı HC, Özgür S, Şahin GT, Akay EÖ, Güzeltaş A, Ergül Y. Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience. J Interv Card Electrophysiol 2020; 62:113-122. [PMID: 32968865 DOI: 10.1007/s10840-020-00868-x] [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: 09/24/2019] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In children with typical atrioventricular nodal reentrant tachycardia (tAVNRT), cryoablation is preferred over radiofrequency ablation (RFA) because of its safety profile and acceptable long-term success rates. In this study, we have assessed the utility of 8-mm tip cryocatheters for tAVNRT ablation in our center. METHODS All pediatric AVNRT patients who underwent cryoablation with an 8-mm tip cryocatheter in our center between 2013 and 2018 were included. EnSite™ (St. Jude Medical Inc., St. Paul, MN, USA) was used in all patients. RESULTS A total of 120 patients (64 females, 53%) were included in this study, and the mean age was 13.9 years with a standard deviation of 2.5 years. Eleven patients (9.1%) had structural heart disease, and 12 patients (10%) had additional arrhythmia substrate. The mean number of effective cryolesions was 8 with a standard deviation of 2.3. Fluoroscopy was used in three patients (2.5%). There were minor complications in only four patients (3.3%)-transient first-degree atrioventricular block or transient incomplete right bundle branch block. Acute success rate of cryoablation was 108/120 (90%). In twelve patients, cryoablation was suboptimal, or it failed. The procedure was completed successfully with RFA in the same session in ten patients. Overall acute success rate of ablation (Cryo ± RFA) was 98.5%. During a mean follow-up period of 24.6 months with a standard deviation of 11.3 months, three patients had recurrence (2.5%). Time between the beginning of the effective cryolesion and termination of AVNRT was found associated with acute success of cryoablation (p = 0.013). CONCLUSIONS Cryoablation of AVNRT with an 8-mm tip catheter in children appears to be safe, with an acceptable acute success rate and a low recurrence rate. A faster termination of AVNRT during the cryolesion, slowing down before ending with atrioventricular block, is a good indicator for acute success.
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Affiliation(s)
- Hasan Candaş Kafalı
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. .,Istanbul Sağlık Bilimleri Universitesi Mehmet Akif Ersoy Eğitim Araştırma Hastanesi, Istasyon Mahallesi İstanbul Caddesi Bezirganbahçe Mevki, 34303, Küçükçekmece/İstanbul, Turkey.
| | - Senem Özgür
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Gülhan Tunca Şahin
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Elif Özkilitçi Akay
- Department of Anesthesiology and Reanimation, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergül
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
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Morley G, Bernstein S, Kuznekoff L, Vasquez C, Saul P, Haemmerich D. Permanent and Transient Electrophysiological Effects During Cardiac Cryoablation Documented by Optical Activation Mapping and Thermal Imaging. IEEE Trans Biomed Eng 2018; 66:1844-1851. [PMID: 30418875 PMCID: PMC6667312 DOI: 10.1109/tbme.2018.2880408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Cardiac catheter cryoablation is a safer alternative to radiofrequency ablation for arrhythmia treatment, but electrophysiological (EP) effects during and after freezing are not adequately characterized. The goal of this study was to determine transient and permanent temperature induced EP effects, during and after localized tissue freezing. METHODS Conduction in right (RV) and left ventricles (LV) was studied by optical activation mapping during and after cryoablation in paced, isolated Langendorff-perfused porcine hearts. Cryoablation was performed endocardially (n=4) or epicardially (n=4) by a cryoprobe cooled to -120 °C for 8 minutes. Epicardial surface temperature was imaged with an infrared camera. Viability staining was performed after ablation. Motion compensation and co-registration was performed between optical mapping data, temperature image data, and lesion images. RESULTS Cryoablation produced lesions 14.9 +/- 3.1 mm in diameter and 5.8 +/- 1.7 mm deep. A permanent lesion was formed in tissue cooled below -5 +/- 4 °C. Transient EP changes observed at temperatures between 17 and 37 °C during cryoablation surrounding the frozen tissue region directly correlated with local temperature, and include action potential (AP) duration prolongation, decrease in AP magnitude, and slowing in conduction velocity (Q10=2.0). Transient conduction block was observed when epicardial temperature reached <17 °C, but completely resolved upon tissue rewarming, within 5 minutes. CONCLUSION Transient EP changes were observed surrounding the permanent cryo lesion (<-5 °C), including conduction block (-5 to 17 °C), and reduced conduction velocity (>17 °C). SIGNIFICANCE The observed changes explain effects observed during clinical cryoablation, including transient increases in effective refractory period, transient conduction block, and transient slowing of conduction. The presented quantitative data on temperature dependence of EP effects may enable the prediction of the effects of clinical cryoablation devices.
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Karacan M, Çelik N, Akdeniz C, Tuzcu V. Long-term outcomes following cryoablation of atrioventricular nodal reentrant tachycardia in children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:255-260. [DOI: 10.1111/pace.13277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/21/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mehmet Karacan
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Nida Çelik
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Celal Akdeniz
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Volkan Tuzcu
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
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Kusterer N, Morales G, Butt M, Darrat Y, Parrott K, Ogunbayo G, Bidwell K, Patel R, Delisle B, Czarapata M, Elayi CS. Junctional ectopic rhythm after AVNRT ablation: An underrecognized complication. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:182-193. [DOI: 10.1111/pace.13260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/21/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan Kusterer
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Gustavo Morales
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Muhammad Butt
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Yousef Darrat
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Kevin Parrott
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Gbolahan Ogunbayo
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Katrina Bidwell
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Ripa Patel
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Brian Delisle
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Melissa Czarapata
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
| | - Claude S. Elayi
- Division of Cardiovascular Medicine, Gill Heart Institute; University of Kentucky and Lexington VAMC; Lexington KY USA
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9
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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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Dechert BE, Dick M, Bradley DJ, LaPage MJ. Variation in Pediatric Post-Ablation Care: A Survey of the Pediatric and Congenital Electrophysiology Society (PACES). Pediatr Cardiol 2017. [PMID: 28620754 DOI: 10.1007/s00246-017-1654-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although catheter ablation is a standard treatment for pediatric arrhythmias, there are no consensus guidelines for follow-up care. This study describes the variation in post-ablation practices identified through a survey of the pediatric and congenital electrophysiology society (PACES). Pediatric and congenital electrophysiology society members were invited to participate in an online survey of post-ablation practices in September 2014. Survey questions targeted routine post-ablation practices for three common arrhythmia substrates: atrioventricular nodal reentry tachycardia, concealed accessory pathways (AP), and manifest APs. Significant practice variation was defined as <90% concordance among respondents. There were 70 respondents from 67 centers, 29 (41%) in practice for <10 years. Uniform practices included aspirin after left side ablation by 65 (93%), immediate post-procedure ECG by 63 (90%), and performance of outpatient follow-up in 69 (99%) including ECG in 97-100% depending on substrate. The majority, 57 (81%), have standardized follow-up independent of substrate. Post-procedural observation is highly variable, with 25 (36%) discharging patients on the day of ablation, 22 (33%) observing patients in hospital overnight, and 21 (30%) basing hospitalization on pre-defined criteria. Immediate post-procedure echo is performed after all ablations in only 16 (23%). Discharge from outpatient care occurs at a median time of 12 months for each arrhythmia substrate. Common post-ablation practices are evident among pediatric electrophysiologists. However, they report significant variation in post-procedure monitoring practices and testing. The rationale for these variances, and their impact on costs and outcomes, should be defined.
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Affiliation(s)
- Brynn E Dechert
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA.
| | - Macdonald Dick
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
| | - David J Bradley
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Martin J LaPage
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
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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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12
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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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13
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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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14
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Use of three-dimensional mapping in young patients decreases radiation exposure even without a goal of zero fluoroscopy. Cardiol Young 2016; 26:1297-302. [PMID: 26507259 DOI: 10.1017/s1047951115002449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
At present, three-dimensional mapping is often used during cardiac ablations with an explicit goal of decreasing radiation exposure; three-dimensional mapping was introduced in our institution in 2007, but not specifically to decrease fluoroscopy time. We document fluoroscopy use and catheterisation times in this setting. Data were obtained retrospectively from patients who underwent ablation for atrioventricular nodal re-entrant tachycardia from January, 2004 to December, 2011. A total of 93 patients were included in the study. Among them, 18 patients who underwent radiofrequency ablation without three-dimensional mapping were included in Group 1, 13 patients who underwent cryoablation without three-dimensional mapping were included in Group 2, and 62 patients who underwent cryoablation with three-dimensional mapping were included in Group 3. Mean fluoroscopy times differed significantly (34.3, 23.4, and 20.3 minutes, p<0.001) when all the groups were compared. Group 3 had a shorter average fluoroscopy time that did not reach significance when compared directly with Group 2 (p=0.29). An unadjusted linear regression model showed a progressive decrease in fluoroscopy time (p=0.002). Mean total catheterisation times differed significantly (180, 211, and 210 minutes, p=0.02) and were related to increased ablation times inherent to cryoablation techniques. Acute success was achieved in 89, 100, and 97% of patients (p=0.25), and chronic success was achieved in 80, 92, and 93% of patients (p=0.38). Complication rates were similar (17, 23, and 7%, p=0.14). In conclusion, three-dimensional mapping systems decrease fluoroscopy times even without an explicit goal of zero fluoroscopy. Efficacy and safety of the procedure have not changed.
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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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Hernandez-Madrid A, Hocini M, Chen J, Potpara T, Pison L, Blomstrom-Lundqvist C. How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm survey. Europace 2014; 16:1852-6. [DOI: 10.1093/europace/euu313] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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HIIPPALA ANITA, HAPPONEN JUHAMATTI. Population-Based Single-Center Outcome for Pediatric Catheter Ablation of Common Supraventricular Tachycardias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 38:115-9. [DOI: 10.1111/pace.12511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 07/07/2014] [Accepted: 07/21/2014] [Indexed: 11/28/2022]
Affiliation(s)
- ANITA HIIPPALA
- Pediatric Cardiology; Children's Hospital; Helsinki University Hospital and University of Helsinki; Helsinki Finland
| | - JUHA-MATTI HAPPONEN
- Pediatric Cardiology; Children's Hospital; Helsinki University Hospital and University of Helsinki; Helsinki Finland
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Hanslik A, Mujagic A, Mlczoch E, Gössinger H, Gwechenberger M, Richter B, Marx M, Albinni S. Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents. Acta Paediatr 2014; 103:e188-93. [PMID: 24484419 DOI: 10.1111/apa.12580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/13/2014] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
AIM Radiofrequency catheter ablation is a standard treatment for tachyarrhythmia in children. Recently, several centres using cryoenergy for ablation have reported high success and low complication rates, but an increased risk of recurrence of arrhythmia. The aim of this study was to report success, complications and recurrence rates for radiofrequency catheter ablation in children under current conditions. METHODS A retrospective cohort study of 333 consecutive children undergoing radiofrequency catheter ablation over the last two decades. RESULTS Radiofrequency catheter ablation was performed successfully in 96.7% of patients, but was significantly less successful in patients with a right anterior or right anterolateral accessory pathway (81.8%). Overall mortality was 0%; there was only one (0.3%) major complication, a pericardial haemorrhage, and only 2.8% of the patients developed minor vascular complications at the puncture site. None of the patients developed a persistent atrioventricular block. Over a median observation time of 4.3 years (0.1; 17.8), recurrence of arrhythmia occurred in 9.3% of all patients, but 50% of children with right lateral accessory pathways. CONCLUSION Radiofrequency catheter ablation can be performed with high success and very low complication rates in children. Recurrence rates are substantially lower than those reported for cryoablation in the literature.
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Affiliation(s)
- Andreas Hanslik
- Division of Paediatric Cardiology; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Azra Mujagic
- Division of Paediatric Cardiology; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Elisabeth Mlczoch
- Division of Paediatric Cardiology; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Heinz Gössinger
- Divison of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - Marianne Gwechenberger
- Divison of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - Bernhard Richter
- Divison of Cardiology; Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | - Manfred Marx
- Division of Paediatric Cardiology; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - Sulaima Albinni
- Division of Paediatric Cardiology; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
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Bhat DP, Du W, Karpawich PP. Testing efficacy in determination of recurrent supraventricular tachycardia among subjectively symptomatic children following "successful" ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1009-16. [PMID: 24646416 DOI: 10.1111/pace.12373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/13/2014] [Accepted: 02/05/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Supraventricular tachycardia (SVT) in children can be successfully terminated using catheter ablation techniques; however, chronic, true success may be less. Sensed tachycardia (ST) is common following ablation and the differentiation from true arrhythmia recurrences can be challenging. METHODS Records of all patients ≤ 18 years who underwent successful ablation for simple forms of SVT and followed-up for at least a year between 2002 and 2012 were reviewed. Patients with congenital heart disease, atrial muscle tachycardia, and associated ventricular tachycardia were excluded. The diagnostic utility of commonly performed tests was assessed. RESULTS Among the 205 eligible subjects, 202 underwent successful ablation (98.5%), of who five were lost to follow-up before 1 year. The early success rate (6 weeks postablation) and mid-term success rate (1 year postablation) were high (97.5% and 87.4%, respectively) whereas the chronic success (5 years postablation) was only 75%. Although true arrhythmia recurrence was significantly higher in the young (mean 11.5 years vs 13.5 years, P = 0.03) and males (P = 0.02), the presence of diffuse, right-sided fibers was the only independent predictor of true recurrence (odds ratio = 2.7, P = 0.03, 95% confidence interval 1.1, 6.8). Significant ST was reported by 111 patients (56%). The 30-day ambulatory event monitor had the highest sensitivity (71%) when compared to exercise test (19%) and electrocardiogram (24%) in identifying true arrhythmia recurrence. CONCLUSIONS Acute and early success may not guarantee chronic ablation success. Postablation, symptomatic patients can be most effectively evaluated using ambulatory event monitoring; however, true recurrence may still be missed and requires closer monitoring.
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Affiliation(s)
- Deepti P Bhat
- Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
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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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Scaglione M, Ebrille E, Caponi D, Blandino A, DI Donna P, Siboldi A, Bertero G, Anselmino M, Raimondo C, Sardi D, Gabbarini F, Marasini M, Gaita F. Single center experience of fluoroless AVNRT ablation guided by electroanatomic reconstruction in children and adolescents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1460-7. [PMID: 23713835 DOI: 10.1111/pace.12183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/26/2013] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anatomical considerations and risks related to x-ray exposure make atrioventricular nodal reentrant tachycardia (AVNRT) ablation in pediatric patients a concerning procedure. We aimed to evaluate the feasibility, safety, and efficacy of performing fluoroless slow-pathway cryoablation guided by the electroanatomic (EA) mapping in children and adolescents. METHODS Twenty-one consecutive patients (mean age 13.5 ± 2.4 years) symptomatic for AVNRT were prospectively enrolled to right atrium EA mapping and electrophysiological study prior to cryoablation. Cryoablation was guided by slow-pathway potential and performed using a 4-mm-tip catheter. RESULTS Sustained slow-fast AVNRT was inducible in all the patients with a dual AV nodal physiology in 95%. Acute success was achieved in 100% of the patients with a median of two cryo-applications. Fluoroless ablation was feasible in 19 patients, while in two subjects 50 seconds and 45 seconds of x-ray were needed due to difficult progression of the catheters along the venous system. After a mean follow-up of 25 months, AVNRT recurred in five patients. All the recurrences were successfully treated with a second procedure. In three patients, a fluoroless cryoablation with a 6-mm-tip catheter was successfully performed, while in the remaining two patients, a single pulse of 60 seconds of radiofrequency energy was applied under fluoroscopic monitoring. No complications occurred. CONCLUSIONS Combination of EA mapping systems and cryoablation may allow to perform fluoroless slow-pathway ablation for AVNRT in children and adolescents in the majority of patients. Fluoroless slow-pathway cryoablation showed a high efficacy and safety comparable to conventional fluoroscopy guided procedures.
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Affiliation(s)
- Marco Scaglione
- Cardiology Department, Cardinal Massaia Hospital, Asti, Italy
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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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Tonet J, De Sisti A, Pardo Restrepo N, Raguin D, Amara W, Márquez MF, Aouate P, Waintraub X, Touil F, Hidden-Lucet F. Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump. J Interv Card Electrophysiol 2012; 35:63-9. [PMID: 22562357 PMCID: PMC3435514 DOI: 10.1007/s10840-012-9680-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE A residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump. METHODS We analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter. Success was defined as AVNRT non-inducibility. Patients with no baseline elicitable jump, no inducible AVNRT, and transient first atrioventricular (AV) block at the last site were excluded. RESULTS From 371 patients who underwent cryoablation from May 2002 to March 2011, 303 fulfilled the entry criteria (mean age, 41 ± 16; 222 women). Baseline AV nodal effective refractory period (ERP) was 272 ± 57 ms, postprocedural 331 ± 64 (P < 0.001), and the mean of the difference (Δ ERP) 60 ± 41. At the end of the procedure, 64 patients (21 %) had a residual jump, of whom 22 with a single echo. At 12 months follow-up, the actuarial recurrence-free rate was 70.3 % in patients with a residual jump and 86 % in those without (P = 0.01). In patients with a jump, only Δ AV nodal ERP was correlated with recurrence (37 ± 41 vs. 68 ± 47 ms; P < 0.04) while a single echo was not. The actuarial rate of recurrence was 60.8 % in patients with a Δ AV nodal ERP ≤ 30 ms and 18.8 % in those with a Δ AV nodal ERP >30 ms (P < 0.01). CONCLUSIONS Suppression of slow pathway conduction is the optimal endpoint for AVNRT cryoablation. A residual jump can be tolerated if AV nodal ERP postcryoablation is prolonged >30 ms.
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Affiliation(s)
- Joelci Tonet
- Cardiology Institute, Rhythmology Unit, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75651 Paris, France.
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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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Reents T, Springer B, Ammar S, Wu J, Fichtner S, Jilek C, Kolb C, Horndasch M, Zhu P, Hess J, Deisenhofer I, Hessling G. Long-term follow-up after cryoablation for adolescent atrioventricular nodal reentrant tachycardia: recurrence is not predictable. Europace 2012; 14:1629-33. [DOI: 10.1093/europace/eus103] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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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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De Sisti A, Tonet J, Amara W, Raguin D, Aouate P, Gueffaf F, Touil F, Hidden-Lucet F. Correlations between long-term results after cryoablation for atrioventricular nodal reentry tachycardia and a residual jump associated or not with a single echo. Europace 2011; 14:261-6. [DOI: 10.1093/europace/eur297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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LaPage MJ, Reed JH, Collins KK, Law IH, Pilcher TA, Tanel RE, Anderson CC, Young ML, Emmel M, Paul T, Blaufox AD, Arora G, Saul JP. Safety and results of cryoablation in patients <5 years old and/or <15 kilograms. Am J Cardiol 2011; 108:565-71. [PMID: 21624545 DOI: 10.1016/j.amjcard.2011.03.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022]
Abstract
Current recommendations discourage elective radiofrequency ablation in patients <5 years old and/or weighing <15 kg, primarily because of the greater complication rate. To describe the current use, complications, and immediate outcomes of cryoablation in this patient population, a multicenter retrospective review of all patients <5 years old and/or weighing <15 kg who were treated with cryoablation for arrhythmia was performed. Eleven centers contributed data for 68 procedures on 61 patients. Of those, 34% were elective and 24% (n = 16) were both cryoablation and radiofrequency ablation. The median age and weight at ablation was 3.5 years (range 8 days to 9.9 years) and 15.2 kg (range 2.3 to 23), respectively. Congenital heart disease was present in 23% of the patients. The immediate success rate of cryoablation alone was 74%. No major complications occurred with cryoablation only; however, 2 of the 16 patients who underwent cryoablation and radiofrequency ablation had major complications. Of the 50 patients receiving cryoablation, 8 (16%) had variable degrees of transient atrioventricular block. The recurrence rate was 20% after cryoablation and 30% after cryoablation plus radiofrequency ablation. In conclusion, cryoablation appears to have a high safety profile in these patients. Compared to older and larger patients, the efficacy of cryoablation in this small, young population was lower and the recurrence rates were higher. Cryoablation's effect on the coronary arteries has not been fully elucidated and requires additional research.
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González-Rosa JM, Martín V, Peralta M, Torres M, Mercader N. Extensive scar formation and regression during heart regeneration after cryoinjury in zebrafish. Development 2011; 138:1663-74. [PMID: 21429987 DOI: 10.1242/dev.060897] [Citation(s) in RCA: 335] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The zebrafish heart has the capacity to regenerate after ventricular resection. Although this regeneration model has proved useful for the elucidation of certain regeneration mechanisms, it is based on the removal of heart tissue rather than its damage. Here, we characterize the cellular response and regenerative capacity of the zebrafish heart after cryoinjury, an alternative procedure that more closely models the pathophysiological process undergone by the human heart after myocardial infarction (MI). Localized damage was induced in 25% of the ventricle by cryocauterization (CC). During the first 24 hours post-injury, CC leads to cardiomyocyte death within the injured area and the near coronary vasculature. Cell death is followed by a rapid proliferative response in endocardium, epicardium and myocardium. During the first 3 weeks post-injury cell debris was cleared and the injured area replaced by a massive scar. The fibrotic tissue was subsequently degraded and replaced by cardiac tissue. Although animals survived CC, their hearts showed nonhomogeneous ventricular contraction and had a thickened ventricular wall, suggesting that regeneration is associated with processes resembling mammalian ventricular remodeling after acute MI. Our results provide the first evidence that, like mammalian hearts, teleost hearts undergo massive fibrosis after cardiac damage. Unlike mammals, however, the fish heart can progressively eliminate the scar and regenerate the lost myocardium, indicating that scar formation is compatible with myocardial regeneration and the existence of endogenous mechanisms of scar regression. This finding suggests that CC-induced damage in zebrafish could provide a valuable model for the study of the mechanisms of scar removal post-MI.
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Affiliation(s)
- Juan Manuel González-Rosa
- Department of Cardiovascular Development and Repair, Centro Nacional de Investigaciones Cardiovasculares CNIC, Calle Melchor Fernández Almagro 3, Madrid 28029, Spain
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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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