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Jimenez E, El-Bokl A, Aggarwal V, Cortez D. Catheter ablation of atrioventricular nodal reentrant tachycardia, when AVNRT presented as a fetus or infant. Pacing Clin Electrophysiol 2023; 46:1310-1314. [PMID: 37793050 DOI: 10.1111/pace.14833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/24/2023] [Accepted: 09/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Atrioventricular nodal reentrant tachycardia (AVNRT) does not commonly present during infancy. Although relative safety of catheter ablation of AVNRT has been demonstrated in pediatrics, this procedure is rarely indicated in children <15 kg. METHODS Retrospective review of seven cases of AVNRT that presented in children younger than 1 year of age and required catheter ablation for definitive management. Electrophysiology (EP) study was planned with two or three catheters. Area of ablation determined by voltage mapping, propagation sinus wave collision and slow pathway potential location. Ablation performed with cryothermal energy. No fluoroscopy was used. RESULTS Presentation ranged from 36 weeks of gestation to 11 months of age. Two presented in fetal life and two in the neonatal period. The median age of ablation was 20 months (range 17-31 months). The median weight at ablation was 11.4 kg (range 8.9-14.9 kg). Median follow-up time was 16 months. All had typical AVNRT. The median tachycardia cycle length was 216 ms. 100% successful rate using cryoablation. No complications. No recurrence of tachycardia during the follow-up period. CONCLUSION Slow AV nodal pathway cryoablation may be safely performed, with good short and medium-term outcomes in patients under 15 kg.
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Affiliation(s)
- Erick Jimenez
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amr El-Bokl
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Cortez
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
- Division of Pediatric Cardiology, UC Davis Medical System, Sacramento, California, USA
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Silvetti MS. The day after the new little ice age… (or the chronic outcome of pediatric slow pathway cryoablation). Heart Rhythm 2021; 19:270-271. [PMID: 34695577 DOI: 10.1016/j.hrthm.2021.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
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Identifying an appropriate endpoint for cryoablation in children with atrioventricular nodal reentrant tachycardia: Is residual slow pathway conduction associated with recurrence? Heart Rhythm 2021; 19:262-269. [PMID: 34601128 DOI: 10.1016/j.hrthm.2021.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cryoablation is increasingly used to treat atrioventricular nodal reentrant tachycardia (AVNRT) due to its safety profile. However, cryoablation may have higher recurrence than radiofrequency ablation (RFA), and the optimal procedural endpoint remains undefined. OBJECTIVE The purpose of this study was to identify the association of cryoablation procedural endpoints with postprocedural AVNRT recurrence. METHODS We performed a single-center, retrospective analysis of pediatric patients following successful first-time cryoablation for AVNRT between January 1, 2011, and December 31, 2019. Preablation inducibility of AVNRT was recorded. Procedural endpoints, including slow pathway (SP) conduction (presence of jump or echo beats) with and without isoproterenol, were identified. Recurrence was established from clinical notes and/or direct patient contact. RESULTS Of 256 patients, 147 (57%) were assessed on isoproterenol precryoablation, and 171 (47%) were assessed on isoproterenol postcryoablation. Mean cryolesion time was 2586 ± 1434 seconds. Following ablation, 104 (41%) had some evidence of residual SP conduction. With median follow-up time of 1.9 [0.7-3.7] years, recurrence occurred in 14 patients (5%). Complete elimination of SP conduction (with and without isoproterenol) had a hazard ratio for recurrence of 1.26 (95% confidence interval [CI] 0.42-3.8; P = .68) on univariate analysis and 1.39 (95% CI 0.36-5.4; P = .63) on multivariate analysis (including demographics, ablation time, 8-mm cryocatheter, and baseline inducibility). CONCLUSION The observed AVNRT recurrence rate after cryoablation was comparable to that of RFA. The presence of residual SP conduction was not associated with recurrence. This suggests that jump or single echo beat may be an acceptable endpoint in AVNRT cryoablation.
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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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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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7
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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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8
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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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10
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Moak JP. Look and you shall find: Perils along the road after slow pathway ablation for AV nodal reentry tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:194-196. [PMID: 29266362 DOI: 10.1111/pace.13261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 12/05/2017] [Accepted: 12/10/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jeffrey P Moak
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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11
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Luani B, Zrenner B, Basho M, Genz C, Rauwolf T, Tanev I, Schmeisser A, Braun-Dullaeus RC. Zero-fluoroscopy cryothermal ablation of atrioventricular nodal re-entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial). J Cardiovasc Electrophysiol 2017; 29:160-166. [DOI: 10.1111/jce.13354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/09/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Blerim Luani
- Department of Internal Medicine, Division of Cardiology and Angiology; Magdeburg University; Magdeburg Germany
| | - Bernhard Zrenner
- Department of Cardiology, Pulmology and Angiology; Landshut-Achdorf Hospital; Landshut Germany
| | - Maksim Basho
- Department of Radiology; University Hospital Center Mother Teresa; Tirana Albania
| | - Conrad Genz
- Department of Internal Medicine, Division of Cardiology and Angiology; Magdeburg University; Magdeburg Germany
| | - Thomas Rauwolf
- Department of Internal Medicine, Division of Cardiology and Angiology; Magdeburg University; Magdeburg Germany
| | - Ivan Tanev
- Department of Internal Medicine, Division of Cardiology and Angiology; Magdeburg University; Magdeburg Germany
| | - Alexander Schmeisser
- Department of Internal Medicine, Division of Cardiology and Angiology; Magdeburg University; Magdeburg Germany
| | - Rüdiger C. Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology; Magdeburg University; Magdeburg Germany
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12
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Pang BJ, Redpath CJ, Green MS. Crossing the slow pathway bridge: A better method for decreasing long-term recurrences after cryoablation of atrioventricular nodal reentrant tachycardia? Heart Rhythm 2017; 14:1655-1656. [PMID: 28765089 DOI: 10.1016/j.hrthm.2017.07.031] [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: 07/22/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Benjamin J Pang
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Calum J Redpath
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martin S Green
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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13
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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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14
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Radiofrequency ablation versus cryoablation for atrioventricular nodal re-entrant tachycardia in children: a value comparison. Cardiol Young 2017; 27:224-228. [PMID: 27087499 DOI: 10.1017/s1047951116000299] [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: 11/08/2022]
Abstract
BACKGROUND It is unclear whether cryoablation or radiofrequency ablation offers better value for treating atrioventricular nodal re-entrant tachycardia in children. We aimed to compare the value of these procedures for treating atrioventricular nodal re-entrant tachycardia in children, with value being outcomes relative to costs. METHODS We performed a retrospective cohort study of all atrioventricular nodal re-entrant tachycardia ablations for children (age⩽18 years) from July, 2009 to June, 2011 at our institution. Costs included fixed costs, miscellaneous hospital costs, and labour costs, and key outcomes were acute and long-term success (6 months) of the ablations. We conducted T-tests and regression analyses to investigate the associations between the ablation procedure type and the cost and success of the ablations. RESULTS Of 96 unique cases performed by three paediatric electrophysiologists, 48 were cryoablation only, 42 radiofrequency ablation only, and six were a combination. Acute success was 100% for the cryoablation only and radiofrequency ablation only cases and 83% for the combination cases. There were no notable adverse events. The average total cost was $9636 for cryoablation cases, $9708 for radiofrequency ablation cases, and $10,967 for combination cases (p=0.51 for cryoablation only versus radiofrequency ablation only). The long-term success rate was 79.1% for cryoablation only, 92.8% for radiofrequency ablation only, and 66.7% for the combination (p=0.01 for cryoablation only versus radiofrequency ablation only), but long-term success varied notably by provider. CONCLUSIONS Cryoablation and radiofrequency ablation offer similar value in the short term for the treatment of atrioventricular nodal re-entrant tachycardia in children. Differences in long-term success may vary substantially by physician, and thus may lead to differences in long-term value.
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15
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George SA, Faye NR, Murillo-Berlioz A, Lee KB, Trachiotis GD, Efimov IR. At the Atrioventricular Crossroads: Dual Pathway Electrophysiology in the Atrioventricular Node and its Underlying Heterogeneities. Arrhythm Electrophysiol Rev 2017; 6:179-185. [PMID: 29326832 DOI: 10.15420/aer.2017.30.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The atrioventricular node (AVN) is a complex structure that performs a variety of functions in the heart. The AVN is primarily an electrical gatekeeper between the atria and ventricles and introduces a delay between atrial and ventricular excitation, allowing for efficient ventricular filling. The AVN is composed of several compartments that safely transmit electrical excitation from the atria to the ventricles via the fast or slow pathways. There are many electrophysiological differences between these pathways, including conduction time and electrical refractoriness, that increase the predisposition of the atrioventricular junction to arrhythmias such as atrioventricular nodal re-entrant tachycardia. These varied electrophysiological characteristics of the fast and slow pathways stem from their unique structural and molecular composition (tissue and cellular geometry, ion channels and gap junctions). This review summarises the structural and molecular heterogeneities of the human AVN and how they result in electrophysiological variations and arrhythmias.
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Affiliation(s)
- Sharon A George
- Department of Biomedical Engineering, The George Washington University,Washington, DC, USA
| | - N Rokhaya Faye
- Department of Biomedical Engineering, The George Washington University,Washington, DC, USA
| | - Alejandro Murillo-Berlioz
- Department of Biomedical Engineering, The George Washington University,Washington, DC, USA.,Division of Cardiothoracic Surgery and Cardiothoracic Research, Veterans Affairs Medical Center,Washington, DC, USA
| | - K Benjamin Lee
- Department of Biomedical Engineering, The George Washington University,Washington, DC, USA.,Division of Cardiothoracic Surgery and Cardiothoracic Research, Veterans Affairs Medical Center,Washington, DC, USA
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery and Cardiothoracic Research, Veterans Affairs Medical Center,Washington, DC, USA
| | - Igor R Efimov
- Department of Biomedical Engineering, The George Washington University,Washington, DC, USA
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Moustafa GA, Kolokythas A, Charitakis K, Avgerinos DV. Therapeutic Utilities of Pediatric Cardiac Catheterization. Curr Cardiol Rev 2016; 12:258-269. [PMID: 26926291 PMCID: PMC5304250 DOI: 10.2174/1573403x12666160301121253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 12/17/2015] [Accepted: 12/27/2015] [Indexed: 11/29/2022] Open
Abstract
In an era when less invasive techniques are favored, therapeutic cardiac catheterization constantly evolves and widens its spectrum of usage in the pediatric population. The advent of sophisticated devices and well-designed equipment has made the management of many congenital cardiac lesions more efficient and safer, while providing more comfort to the patient. Nowadays, a large variety of heart diseases are managed with transcatheter techniques, such as patent foramen ovale, atrial and ventricular septal defects, valve stenosis, patent ductus arteriosus, aortic coarctation, pulmonary artery and vein stenosis and arteriovenous malformations. Moreover, hybrid procedures and catheter ablation have opened new paths in the treatment of complex cardiac lesions and arrhythmias, respectively. In this article, the main therapeutic utilities of cardiac catheterization in children are discussed.
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Affiliation(s)
| | | | | | - Dimitrios V Avgerinos
- Department of Cardiothoracic Surgery, Athens Medical Center & Center for Percutaneous Valves and Aortic Diseases, 5-7 Distomou Street, 15125, Marousi, Attica, Greece.
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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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Bellmann B, Roser M, Muntean BG. Successful re-ablation of a permanent junctional reciprocating tachycardia with cryoenergy : Case report of a 19-year-old patient. Wien Med Wochenschr 2016; 168:152-155. [PMID: 27324511 DOI: 10.1007/s10354-016-0458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/18/2016] [Indexed: 11/26/2022]
Abstract
We report the case of a 19-year-old male patient who presented with a permanent junctional reciprocating tachycardia (PJRT). After a primarily successful radiofrequency ablation of a para-Hisian, midseptal, accessory pathway, recurrence of tachycardia was documented. Thereafter, successful ablation using cryoenergy was performed. Since this second ablation the patient has been free of tachycardia. Our case study shows that the treatment of PJRT in young adults using cryoenergy can be successfully and safely conducted, especially after tachycardia recurrence following an initial radiofrequency ablation.
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Affiliation(s)
- Barbara Bellmann
- Department of Cardiology, Charité Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Mattias Roser
- Department of Cardiology, Charité Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bogdan G Muntean
- Department of Cardiology, Charité Berlin Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
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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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Leila R, Raluca P, Yves DG, Dirk S, Bruno S. Cryoablation Versus Radiofrequency Ablation in AVNRT: Same Goal, Different Strategy. J Atr Fibrillation 2015; 8:1220. [PMID: 27957174 DOI: 10.4022/jafib.1220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/07/2015] [Accepted: 05/11/2015] [Indexed: 11/10/2022]
Abstract
Catheter ablation is nowadays the first therapeutic option for AVNRT, the most common benign supraventricular tachycardia. Both cryotherapy and radiofrequency energy may be used to ablate the slow pathway. This paper compares both techniques, evaluates results published in literature and gives feedback on some typical aspects of cryo- and RF ablation. Although both techniques have satisfying success rates in AVNRT ablation, with a higher safety profile of cryoablation towards creation of inadvertent atrioventricular block, it remains paramount that the operator respects the distinctive traits of each technique in order to obtain an optimal result in every patient.
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21
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Happonen JM, Blom N, Celiker A, Drago F, Hebe J, Janousek J, Kornyei L, Kriebel T, Papagiannis J, Paul T, Pfammatter JP, Rosenthal E, Tuzcu V. Management of paediatric arrhythmias in Europe. Europace 2015; 17:1879. [PMID: 25995398 DOI: 10.1093/europace/euv091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Juha-Matti Happonen
- Pediatric Cardiology, Helsinki University Children's Hospital, POB 281, Helsinki 00029, Finland
| | - Nico Blom
- Leiden University Medical Center, Leiden, The Netherlands
| | - Alpay Celiker
- Department of Pediatric Cardiology, Koc University, Istanbul, Turkey
| | - Fabrizio Drago
- Ospedale Pediatrico Bambino Gesù, Palidoro-Fiumicino (Rome), Italy
| | - Joachim Hebe
- Center for Electrophysiology, Heart Center, Bremen, Germany
| | - Jan Janousek
- Children's Heart Center, University Hospital Motol, Prague, Czech Republic
| | - Laszlo Kornyei
- Hungarian Pediatric Heart Center, Hungarian Institute of Cardiology, Budapest, Hungary
| | - Thomas Kriebel
- Pediatric Cardiology, Westpfalz-Klinikum, Kaiserslautern, Germany
| | - John Papagiannis
- Children's Mercy Hospital, Kansas, MO, USA Mitera Children's Hospital, Athens, Greece
| | | | | | - Eric Rosenthal
- Evelina London Children's Hospital, St Thomas' Hospital, London, UK
| | - Volkan Tuzcu
- Pediatric and Genetic Arrhythmia Center Istanbul, Medipol University Hospital, Istanbul, Turkey
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