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Acute outcomes of three-dimensional mapping for fluoroscopy reduction in paediatric catheter ablation for supraventricular tachycardia. Cardiol Young 2021; 31:1923-1928. [PMID: 33766172 DOI: 10.1017/s1047951121001086] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Catheter ablation is a safe and effective therapy for the treatment of supraventricular tachycardia in children. Current improvements in technology have allowed progressive reduction in radiation exposure associated with the procedure. To assess the impact of three-dimensional mapping, we compared acute procedural results collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to published results from the Prospective Assessment after Pediatric Cardiac Ablation study. METHODS Inclusion and exclusion criteria from the Prospective Assessment after Pediatric Cardiac Ablation study were used as guidelines to select patient data from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry to compare acute procedural outcomes between cohorts. Outcomes assessed include procedural and fluoroscopy exposure times, success rates of procedure, and complications. RESULTS In 786 ablation procedures, targeting 498 accessory pathways and 288 atrioventricular nodal reentrant tachycardia substrates, average procedural time (156.5 versus 206.7 minutes, p < 0.01), and fluoroscopy time (1.2 versus 38.3 minutes, p < 0.01) were significantly shorter in the study group. Success rates for the various substrates were similar except for manifest accessory pathways which had a significantly higher success rate in the study group (96.4% versus 93.0%, p < 0.01). Major complication rates were significantly lower in the study group (0.3% versus 1.6%, p < 0.01). CONCLUSIONS In a large, multicentre study, three-dimensional systems show favourable improvements in clinical outcomes in children undergoing catheter ablation of supraventricular tachycardia compared to the traditional fluoroscopic approach. Further improvements are anticipated as technology advances.
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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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3
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Noten AME, Kammeraad JAE, Ramdat Misier NL, Wijchers S, van Beynum IM, Dalinghaus M, Krasemann TB, Yap SC, de Groot NMS, Szili-Torok T. Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation. IJC HEART & VASCULATURE 2021; 37:100881. [PMID: 34646933 PMCID: PMC8495098 DOI: 10.1016/j.ijcha.2021.100881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/17/2021] [Accepted: 09/20/2021] [Indexed: 11/25/2022]
Abstract
Background Catheter ablation (CA) is the first-choice treatment for tachyarrhythmia in children. Currently available CA techniques differ in mechanism of catheter navigation and energy sources. There are no large studies comparing long-term outcomes between available CA techniques in a pediatric population with atrioventricular reentry tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective This study aimed to compare procedural and long-term outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT performed in children without structural heart disease from 2008 to 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was long-term recurrence of tachyarrhythmia. Results In total, we included 223 patients, aged 14 (IQR 12-16) years; weighting 56 (IQR 47-65) kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using CRYO. RMN had significantly lower recurrence rates compared to MAN and CRYO at mean follow-up of 5.5 ± 2.9 years (AVRT: 4.3% versus 15.6% versus 54.5%, P < 0.001; AVNRT: 7.7% versus 8.3% versus 35.7%, P = 0.008; for RMN versus MAN versus CRYO respectively). In AVNRT ablation, RMN had significantly lower fluoroscopy doses compared to CRYO [30 (IQR 20-41) versus 45 (IQR 29-65) mGy, P = 0.040). Conclusion In pediatric patients without structural heart disease who underwent their first AV(N)RT ablation, RMN has superior long-term outcomes compared to MAN and CRYO, in addition to favorable fluoroscopy doses.
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Key Words
- AP, accessory pathway
- AVNRT, atrioventricular nodal reentry tachycardia
- AVRT, atrioventricular reentry tachycardia
- Atrioventricular nodal reentry tachycardia
- Atrioventricular reentry tachycardia
- CA, catheter ablation
- CHD, congenital heart defect
- CRYO, cryoablation
- Catheter ablation
- Cryoablation
- DAP, dose area product
- EAM, electro-anatomic mapping
- ECG, electrocardiogram
- MAN, manual
- Pediatrics
- RF, radiofrequency
- RMN, remote magnetic navigation
- Radiofrequency ablation
- Remote magnetic navigation
- SVT, supraventricular tachycardia
- Supraventricular tachycardia
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Affiliation(s)
- Anna M E Noten
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Nawin L Ramdat Misier
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sip Wijchers
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ingrid M van Beynum
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Thomas B Krasemann
- Department of Pediatric Cardiology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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4
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Walsh MA, Gonzalez CM, Uzun OJ, McMahon CJ, Sadagopan SN, Yue AM, Seller N, Hares DL, Bhole V, Till J, Wong L, Mangat JS, Lowe MD, Rosenthal E, Bowes M, Stuart AG. Outcomes From Pediatric Ablation: A Review of 20 Years of National Data. JACC Clin Electrophysiol 2021; 7:1358-1365. [PMID: 34217658 DOI: 10.1016/j.jacep.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study set out to examine outcomes from pediatric supraventricular tachycardia ablations over a 20-year period. This study sought to examine success rates and repeat ablations over time and to evaluate whether modalities such as 3-dimensional (3D) mapping, contact force, and cryotherapy have improved outcomes. BACKGROUND Ablation of supraventricular tachycardia in pediatric patients is commonly performed in most congenital heart centers with excellent long-term results. METHODS Data were retrieved from the NICOR (National Institute of Clinical Outcomes Research) database in the United Kingdom. Outcomes over time were evaluated, and procedure-related details were compared. RESULTS There were 7,069 ablations performed from January 1, 1999, to December 31, 2018, at 10 centers. Overall, ablation success rates were 92% for accessory pathways, 97% for atrioventricular node re-entry tachycardia, and 89% for atrial tachycardia. There was an improvement in procedural success rates over time (p < 0.01). The use of 3D mapping did not alter success or need for repeat ablation but was associated with a higher proportion of lower fluoroscopy cases; 55% of 3D mapping cases used < 5 min of fluoroscopy (p < 0.01). Patients needing a repeat ablation were 341 (12%) for accessory pathways, 128 (7%) for atrioventricular node re-entry tachycardia, and 35 (7%) for atrial tachycardia. Overall, the risk of complete heart block was low (12 patients, <0.01%). The use of cryotherapy was associated with an increased risk of needing a repeat ablation. CONCLUSIONS Overall success rates from pediatric ablations are excellent and compare favorably to other registries. Introduction of newer technologies have likely made procedures safer and reduced radiation exposure, but they have not changed success rates or the need for a repeat procedure.
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Affiliation(s)
- Mark A Walsh
- Department of Pediatric Cardiology, Children's Health Ireland, Crumlin, Dublin, Ireland.
| | - Cecilia M Gonzalez
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol Heart Institute, University Hospital Bristol, Bristol, United Kingdom
| | - Orhan J Uzun
- Department of Pediatric Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
| | - Colin J McMahon
- Department of Pediatric Cardiology, Children's Health Ireland, Crumlin, Dublin, Ireland
| | - Shankar N Sadagopan
- Department of Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Arthur M Yue
- Department of Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Neil Seller
- Department of Congenital Cardiology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Dominic L Hares
- Department of Cardiology, The Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
| | - Vinay Bhole
- Pediatric Cardiology, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Jan Till
- Department of Congenital Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Leonie Wong
- Department of Congenital Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Jasveer S Mangat
- Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Martin D Lowe
- Pediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
| | - Eric Rosenthal
- Department of Pediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Michael Bowes
- Department of Pediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Alan G Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol Heart Institute, University Hospital Bristol, Bristol, United Kingdom
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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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6
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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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7
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Schneider HE, Stahl M, Schillinger W, Müller M, Backhoff D, Schill M, Groene N, Krause U, Sigler M, Paul T. Double cryoenergy application (freeze-thaw-freeze) at growing myocardium: Lesion volume and effects on coronary arteries late after energy application. Implications for efficacy and safety in pediatric patients. J Cardiovasc Electrophysiol 2019; 30:1127-1134. [PMID: 31111603 DOI: 10.1111/jce.13993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cryoenergy is accepted as an alternative to radiofrequency ablation (RFA) in childen for ablation of supraventricular tachycardia substrates. Single cryoenergy application has been shown to be inferior to RFA. Double cryoenergy application has therefore been introduced into clinical practice, but experience concerning efficacy is limited. Coronary artery stenosis has been reported as serious complication after RFA for arrhythmia substrates but not after single cryoablation. The purpose of the study was to assess lesion volume (efficacy) and risk of coronary artery damage (safety), late, that is, 6 months, after double cryoenergy application in a piglet model. METHODS Two sequential cycles of cryoenergy were delivered at -75°C for 4 minutes at the atrioventricular groove in five piglets. Animals were restudied after 6 months by coronary angiography and intracoronary ultrasound (ICUS). Ablation lesions were examined histologically and lesion volume was determined by three-dimensional morphometric analysis. RESULTS Cryolesion volume was 174.04 ± 67.18 mm3 for atrial and 238.69 ± 112.1 mm3 for ventricular lesions (P > .05). Ventricular lesions, 4.06 ± 1.05 mm, were significantly deeper than atrial lesions, 3.58 ± 0.78 mm, (P < .05). In two of the 29 lesions, cryoenergy induced minor coronary artery injury with mild medial and adventitial thickening as well as minimal intimal proliferation, which had neither been detected by coronary angiography nor by ICUS. CONCLUSION Late after double cryoenergy application at growing myocardium, subclinical minor affection of the coronary artery wall could be detected with minimal intimal proliferation. As lifetime sequelae of this finding remains unknown, further studies are warranted to address safety of repeated cycles of cryoenergy application for tachycardia substrates in children.
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Affiliation(s)
- Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Maja Stahl
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Wolfgang Schillinger
- Department of Cardiology and Pneumology, Georg-August-University Göttingen, Göttingen, Germany
| | | | - David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Manfred Schill
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Nehle Groene
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Matthias Sigler
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg-August-University Göttingen, Göttingen, Germany
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8
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Siebels H, Sohns C, Nürnberg JH, Siebels J, Langes K, Hebe J. Value of an old school approach: safety and long-term success of radiofrequency current catheter ablation of atrioventricular nodal reentrant tachycardia in children and young adolescents. J Interv Card Electrophysiol 2018; 53:267-277. [DOI: 10.1007/s10840-018-0367-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
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9
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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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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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Effects of Triple Cryoenergy Application on Lesion Formation and Coronary Arteries in the Developing Myocardium. Pediatr Cardiol 2017; 38:663-668. [PMID: 28078383 DOI: 10.1007/s00246-016-1564-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/30/2016] [Indexed: 10/20/2022]
Abstract
To improve long-term outcome after cryoablation of substrates of supraventricular tachycardia, application of two and three consecutive freeze-thaw cycles has been performed. The effect of triple freeze-thaw cycles on lesion formation within developing myocardium and coronary arteries, however, has not been studied yet. In eight piglets (mean age 15 weeks, weight 15-20 kg), 30 cryolesions (three consecutive freeze-thaw cycles) were applied to the atrial aspect of both AV valve annuli (n = 18) as well as to ventricular myocardium below the valves (n = 12). Coronary angiography was performed before and after cryoenergy application. The animals were reevaluated by coronary angiography and intracoronary ultrasound (ICUS) after 48 h. All hearts were removed for histological examination of the lesions subsequently. After staining (hematoxylin-eosin, desmin immunohistochemistry), lesions was measured by planimetry with a digital virtual miscroscope analysis system and volumes of the cryolesions were calculated. Mean atrial lesion volume was 190.68 ± 167.53 mm3 (n = 18), and mean ventricular lesion volume was 184.34 ± 107.42 mm3 (n = 12). Compared with previously reported data on lesion volumes after single and double freeze-thaw cycles, lesions were significantly larger. Coronary arteries were unaffected on coronary angiography as well as on ICUS. No affection of coronary arteries was found on histological examination. Application of three consecutive freeze-thaw cycles resulted in increased lesion volume compared with single and double freeze-thaw cycles. No affection of the coronary arteries was evident. To evaluate the clinical benefit and safety of triple cryoenergy application for catheter ablation, prospective randomized trials are required.
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12
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Backhoff D, Klehs S, Müller MJ, Schneider HE, Kriebel T, Paul T, Krause U. Long-Term Follow-Up After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004264. [DOI: 10.1161/circep.116.004264] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
Abstract
Background—
Catheter ablation of the slow conducting pathway (SP) is treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT). Although there are abundant data on AVNRT ablation in adult patients, little is known about the long-term results ≥3 years after AVNRT ablation in pediatric patients.
Methods and Results—
Follow-up data from 241 patients aged ≤18 years who had undergone successful AVNRT ablation were analyzed. Median age at ablation had been 12.5 years, and median follow-up was 5.9 years. Radiofrequency current had been used in 168 patients (70%), whereas cryoenergy had been used in 73 patients (30%). Procedural end point of AVNRT ablation had been either SP ablation (no residual dual atrioventricular nodal physiology) or SP modulation (residual SP conduction allowing for a maximum of one atrial echo beat). After the initial AVNRT ablation, calculated freedom from AVNRT was 96% at 1 year, 94% at 3 years, 93% at 5 years, and 89% at 8 years. Age, sex, body weight, the choice of ablation energy, and the procedural end point of AVNRT ablation did not impact freedom from AVNRT. Six of 22 AVNRT recurrences (27%) occurred ≥5 years after ablation. No late complications including atrioventricular block were noted.
Conclusions—
Cumulatively, catheter ablation of AVNRT continued to be effective in >90% of our pediatric patients during the long-term course. A significant part of recurrences occurred >5 years post ablation. Body weight, energy source, and the end point of ablation had no impact on long-term results. No adverse sequelae were noted.
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Affiliation(s)
- David Backhoff
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Sophia Klehs
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Matthias J. Müller
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Heike E. Schneider
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Kriebel
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Paul
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Ulrich Krause
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
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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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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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15
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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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16
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Pieragnoli P, Paoletti Perini A, Checchi L, Carrassa G, Giomi A, Carrai P, Michelucci A, Padeletti L, Ricciardi G. Cryoablation of typical AVNRT: Younger age and administration of bonus ablation favor long-term success. Heart Rhythm 2015; 12:2125-31. [PMID: 26031373 DOI: 10.1016/j.hrthm.2015.05.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cryoablation (CA) is an emerging tool for the treatment of supraventricular tachyarrhythmias. Determinants of long-term success still need clarification. OBJECTIVE The purpose of this study was to assess which patients' and procedural features affect the long-term efficacy of CA for typical atrioventricular nodal reentrant tachycardia (AVNRT). METHODS Eighty-five consecutive patients undergoing CA for typical AVNRT were divided into 3 groups of age: group A, ≤20 years, n = 20 (23.5%); group B, 21-50 years, n = 30 (35.3%); group C, ≥51 years, n = 35 (41.2%). CA was performed for 5 minutes at -75°C in all; 4-minute bonus CA was delivered if not contraindicated (ie, transient PR interval lengthening during the first application and narrow triangle of Koch). The efficacy end point was the absence of recurrences at 12-month follow-up. RESULTS CA was acutely successful in all 85 patients (100%). Bonus ablation was performed in 69 (81.2%). No permanent complications were observed. At follow-up, AVNRT recurrences occurred in 9 patients (10.6%): group A, 0 (0%); group B, 2 (6.7%), group C, 7 (20%). Incidence of recurrences was significantly different between age groups (P = .047) and between patients receiving (7.2%) and not receiving (25.0%) bonus CA (P = .038). In multivariable analysis, age groups (odds ratio [OR] 5.917; 95% confidence interval [CI] 1.372-25.518; P = .017) and bonus CA (OR 0.115; 95% CI 0.018-0.724; P = .021) were the only independent predictors of recurrences. Furthermore, age as a continuous variable remained statistically associated with recurrences (OR 1.046; 95% CI 1.002-1.091; P = .038). CONCLUSION CA is effective and safe for typical AVNRT ablation. Younger age and bonus CA administration are independent predictors of success at 12 months. Incidence of recurrences is low in patients younger than 21 years.
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Affiliation(s)
- Paolo Pieragnoli
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | | | - Luca Checchi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
| | - Gianmarco Carrassa
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Andrea Giomi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Paolo Carrai
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Antonio Michelucci
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
| | - Luigi Padeletti
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy; Department of Cardiology, Cliniche Gavazzeni, Bergamo, Italy
| | - Giuseppe Ricciardi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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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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18
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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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19
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DESAI VIBHAC, KELTON CHRISTINAM, CZOSEK RICHARDJ, HEATON PAMELAC. Frequencies, Costs, and Complications of Catheter Ablation for Tachyarrhythmias in Children: 2000-2009. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1468-80. [DOI: 10.1111/pace.12191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/16/2013] [Accepted: 04/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- VIBHA C.A. DESAI
- James L. Winkle College of Pharmacy; University of Cincinnati; Cincinnati Ohio
| | - CHRISTINA M.L. KELTON
- Carl H. Lindner College of Business and College of Pharmacy; University of Cincinnati; Cincinnati Ohio
| | - RICHARD J. CZOSEK
- Department of Pediatric Cardiology; The Heart Institute, Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | - PAMELA C. HEATON
- James L. Winkle College of Pharmacy; University of Cincinnati; Cincinnati Ohio
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20
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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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21
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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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22
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SCHNEIDER HEIKEE, STAHL MAJA, KRIEBEL THOMAS, SCHILLINGER WOLFGANG, SCHILL MANFRED, JAKOBI JOHANNES, PAUL THOMAS. Double Cryoenergy Application (Freeze-Thaw-Freeze) at Growing Myocardium: Lesion Volume and Effects on Coronary Arteries Early After Energy Application. Implications for Efficacy and Safety in Pediatric Patients. J Cardiovasc Electrophysiol 2013; 24:701-7. [DOI: 10.1111/jce.12085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - MAJA STAHL
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - THOMAS KRIEBEL
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - WOLFGANG SCHILLINGER
- Department for Cardiology and Pneumology; Georg-August-University, Göttingen; Germany
| | - MANFRED SCHILL
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - JOHANNES JAKOBI
- Department for Pediatric Cardiology and Intensive Care Medicine
| | - THOMAS PAUL
- Department for Pediatric Cardiology and Intensive Care Medicine
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Peyrol M, Sbragia P, Uhry S, Boccara G, Dolla E, Quatre A, Guenoun M, Lévy S, Paganelli F. Slow pathway elimination for atrioventricular nodal reentrant tachycardia with the 8-mm tip cryoablation catheter: an 18-month follow-up study. J Interv Card Electrophysiol 2012; 37:105-9. [DOI: 10.1007/s10840-012-9768-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
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Das S, Law IH, Von Bergen NH, Bradley DJ, Dick M, Etheridge SP, Saarel EV, Frias PA, Strieper MJ, Fischbach PS. Cryoablation therapy for atrioventricular nodal reentrant tachycardia in children: a multicenter experience of efficacy. Pediatr Cardiol 2012; 33:1147-53. [PMID: 22430375 DOI: 10.1007/s00246-012-0273-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT), a common tachycardia in children, is routinely treated by catheter ablation using radiofrequency or cryothermal energy. Acute success rates of 95-97 % are reported for cryoablation, similar to those achieved with radiofrequency ablation (RFA). However, early studies reported higher recurrence rates after cryoablation for treatment of AVNRT than those reported for RFA. This study evaluated the success and recurrence rates for cryoablation in a current cohort of pediatric patients across several institutions. Patients 21 years old or younger with AVNRT who underwent cryoablation at five participating centers between 2004 and 2009 were retrospectively reviewed. Patient demographics and procedural data were extracted from patient records and analyzed. A total of 434 patients with AVNRT who underwent cryoablation were identified. Cryoablation was used as the exclusive ablation method for 379 patients. For 97 % (368/379) of these patients, cryoablation was acutely successful. A higher acute success rate was found with the 6-mm-tip catheter (99 %) than with the 4-mm-tip catheter (91 %) (p < 0.01). Recurrence was experienced by 7.3 % of the patients. Recurrence was more likely for those treated with the 4-mm-tip catheter (6/42, 14 %) than for those who had the larger catheters (12/204, 6 %) No patient experienced permanent heart block. Success and recurrence rates for this cohort of patients were similar to those reported for RFA used to treat AVNRT in pediatric patients. The findings show a higher success rate and a lower recurrence rate after cryoablation with a 6-mm-tip catheter than after use of the 4-mm-tip catheter, with an associated excellent safety profile.
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Affiliation(s)
- Srikant Das
- Sibley Heart Center, Children's Healthcare of Atlanta, Emory University, 2835 Brandywine Road, Ste. 300, Atlanta, GA 30341, USA
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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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Maltret A, Lacotte J. Tachycardies supraventriculaires de l’enfant : histoire naturelle et prise en charge. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2012. [DOI: 10.1016/s1878-6480(12)70826-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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ECKHARDT LEELL, LEAL MIGUEL, HOLLIS ZACHARY, TANEGA JEANETTE, ALBERTE CESAR. Cryoablation for AVNRT: Importance of Ablation Endpoint Criteria. J Cardiovasc Electrophysiol 2012; 23:729-34. [DOI: 10.1111/j.1540-8167.2011.02289.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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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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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