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Janson CM, Shah MJ, Kennedy KF, Iyer VR, Sweeten TL, Glatz AC, Steven JM, O'Byrne ML. Comparison of Outcomes of Pediatric Catheter Ablation by Anesthesia Strategy: A Report From the NCDR IMPACT Registry. Circ Arrhythm Electrophysiol 2021; 14:e009849. [PMID: 34137629 DOI: 10.1161/circep.121.009849] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, Department of Pediatrics (C.M.J., M.J.S., V.R.I., T.L.S., A.C.G., M.L.O.)
| | - Maully J Shah
- Division of Cardiology, Department of Pediatrics (C.M.J., M.J.S., V.R.I., T.L.S., A.C.G., M.L.O.)
| | - Kevin F Kennedy
- University of Pennsylvania. Mid America Heart Institute, St Luke's Health System, Kansas City, MO (K.F.K.)
| | - V Ramesh Iyer
- Division of Cardiology, Department of Pediatrics (C.M.J., M.J.S., V.R.I., T.L.S., A.C.G., M.L.O.)
| | - Tammy L Sweeten
- Division of Cardiology, Department of Pediatrics (C.M.J., M.J.S., V.R.I., T.L.S., A.C.G., M.L.O.)
| | - Andrew C Glatz
- Division of Cardiology, Department of Pediatrics (C.M.J., M.J.S., V.R.I., T.L.S., A.C.G., M.L.O.).,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia (A.C.G., M.L.O.)
| | - James M Steven
- Department of Anesthesia and Critical Care, Department of Anesthesia (J.M.S.)
| | - Michael L O'Byrne
- Division of Cardiology, Department of Pediatrics (C.M.J., M.J.S., V.R.I., T.L.S., A.C.G., M.L.O.).,Center for Pediatric Clinical Effectiveness and Leonard Davis Institute and Center for Cardiovascular Outcomes, Quality, and Evaluative Research (M.L.O.).,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia (A.C.G., M.L.O.)
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"If at first you don't succeed": repeat ablations in young patients with supraventricular tachycardia. J Interv Card Electrophysiol 2019; 59:423-429. [PMID: 31834569 DOI: 10.1007/s10840-019-00672-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/19/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Success rates for catheter ablation of supraventricular tachycardia (SVT) in the young exceed 90%. While studies have described reasons for initial ablation failure, less is known about outcomes of repeat ablation attempts. The purpose of this study was to report acute and mid-term success rates for second ablation attempts in young patients, as well as to analyze factors that may affect these outcomes. METHODS Retrospective single-center study of all patients undergoing a second ablation attempt for WPW (Wolff-Parkinson-White) or SVT from 2008 to 2017. Inclusion criteria are all patients < 21 years old at the time of their first ablation who underwent a second ablation attempt. An intention to treat analysis was performed. RESULTS Fifty-five patients met inclusion criteria, with a median age of 15 years (IQR 12-16). The most common arrhythmia mechanisms at repeat procedure were single accessory pathways (n = 32, 58%) and AVNRT (n = 14, 25%). Six patients (11%) were found to have a different SVT mechanism than at initial ablation. Acute success at repeat ablation was achieved in 48 patients (87%). At mid-term follow-up (10.5 months, IQR 0.6-25), four patients (8% of acute successes) experienced SVT recurrence. The overall success rate of repeat ablations, accounting for acute and mid-term failures, was 80%. CONCLUSIONS In this report of 55 young patients who underwent repeat ablation for WPW and/or SVT, acute and mid-term success rates were 87% and 80%, respectively. These data may help inform decision-making when caring for patients with persistent or recurrent SVT after an initial ablation attempt.
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Janson CM, Ceresnak SR, Choi JM, Dubin AM, Motonaga KS, Mann GE, Kahana M, Fitz-James I, Wise-Faberowski L, Kamra K, Nappo L, Trela A, Pass RH. A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation. Pediatr Cardiol 2019; 40:126-132. [PMID: 30178187 DOI: 10.1007/s00246-018-1968-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022]
Abstract
Catheter stability, an important factor in ablation success, is affected by ventilation. Optimal ventilation strategies for pediatric catheter ablation are not known. We hypothesized that small tidal volume and positive end-expiratory pressure are associated with reduced ablation catheter movement at annular positions. Subjects aged 5-25 years undergoing ablation for supraventricular tachycardia (SVT) or WPW at two centers from March 2015 to September 2016 were prospectively enrolled and randomized to receive mechanical ventilation with either positive end-expiratory pressure of 5 cm H2O (PEEP) or 0 cm H2O (ZEEP). Movement of the ablation catheter tip at standard annular positions was measured using 3D electroanatomic mapping systems under two conditions: small tidal volume (STV) (3-5 mL/kg) or large TV (LTV) (6-8 mL/kg). 58 subjects (mean age 13.8 years) were enrolled for a total of 266 separate observations of catheter movement. STV ventilation was associated with significantly reduced catheter movement, compared to LTV at all positions (right posteroseptal: 2.5 ± 1.4 vs. 5.2 ± 3.1 mm, p < 0.0001; right lateral: 2.7 ± 1.6 vs. 6.3 ± 3.5 mm, p < 0.0001; left lateral: 1.8 ± 1.0 vs. 4.3 ± 1.9 mm, p < 0.0001). The presence or absence of PEEP had no effect on catheter movement. In multivariable analysis, STV was associated with a 3.1-mm reduction in movement (95% CI 2.6-3.5, p < 0.0001), adjusting for end-expiratory pressure, annular location, and patient size. We conclude that STV ventilation is associated with reduced ablation catheter movement compared to a LTV strategy, independent of PEEP and annular position.
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Affiliation(s)
- Christopher M Janson
- Division of Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA.
- Children's Hospital of Philadelphia, 8NW, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Scott R Ceresnak
- Division of Cardiology, Lucile Packard Children's Hospital/Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Jaeun M Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA
| | - Anne M Dubin
- Division of Cardiology, Lucile Packard Children's Hospital/Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Kara S Motonaga
- Division of Cardiology, Lucile Packard Children's Hospital/Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Glenn E Mann
- Division of Anesthesiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Madelyn Kahana
- Division of Anesthesiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Ingrid Fitz-James
- Division of Anesthesiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Lisa Wise-Faberowski
- Division of Anesthesiology, Lucile Packard Children's Hospital/Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Komal Kamra
- Division of Anesthesiology, Lucile Packard Children's Hospital/Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Lynn Nappo
- Division of Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
| | - Anthony Trela
- Division of Cardiology, Lucile Packard Children's Hospital/Stanford University School of Medicine, 725 Welch Rd, Palo Alto, CA, 94304, USA
| | - Robert H Pass
- Division of Cardiology, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA
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