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Tseng WC, Wu MH, Lu CW, Wu KL, Wang JK, Lin MT, Chen CA, Chiu SN. Combination of Slow Pathway Late Activation Maps and Voltage Gradient Maps in Guidance of Atrioventricular Nodal Reentry Tachycardia Cryoablation. Heart Rhythm 2023:S1547-5271(23)02105-7. [PMID: 37075960 DOI: 10.1016/j.hrthm.2023.04.006] [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: 02/12/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The optimal strategy for electroanatomic mapping-guided cryoablation of atrioventricular nodal reentry tachycardia (AVNRT) remains unclear. OBJECTIVE To investigate the effectiveness of slow pathway late activation mapping (SPLAM) and voltage gradient mapping for AVNRT cryoablation. METHODS From June 2020 to February 2022, all consecutive patients with AVNRT underwent SPLAM to define the wave collision point and voltage gradient mapping to define the low voltage bridge (LVB). Conventional procedures performed from August 2018 to May 2020 served as control. RESULTS The study and control groups comprised 36 (aged 16.5±8.2 years) and 37 patients (aged 15.5±7.3 years), respectively. Total procedural times were comparable, and acute success rates were 100% in both groups. Compared to controls, number of cryomapping attempts (median 3 vs. 5, p=0.012) and cryoablation applications (median 1 vs. 2, p<0.001) were significantly lower in the study group. At a median follow-up of 14.6 and 18.3 months, recurrence rates were 5.6% (2 patients) and 10.8% (4 patients) in the study and control groups (p=0.402), respectively. Mapping of Koch's triangle took 11.8±3.6 min, in which 1562±581 points were collected. In SPLAM, wave collision points were defined and compatible with the final successful lesion sites in all patients, including those with multiple slow pathways. LVB could not be defined in 6 patients (16.7%), and LVB was not compatible with the final successful lesion in another 6 (16.7%). CONCLUSIONS For AVNRT cryoablation, SPLAM could effectively guide the localization of slow pathway ablation sites and was particularly beneficial in patients with multiple slow pathways.
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Affiliation(s)
- Wei-Chieh Tseng
- Department of Emergency Medicine, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan; Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Kun-Lang Wu
- Department of Pediatrics, Changhua Christian Hospital, Changhua, Taiwan. No. 320, Xuguang Rd., Changhua City, Changhua County 500, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital/National Taiwan University Children's Hospital. No 7 & 8, Chun-Shan South Road, Taipei 100, Taiwan.
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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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Drago F, Calvieri C, Russo MS, Remoli R, Pazzano V, Battipaglia I, Gimigliano F, Allegretti G, Silvetti MS. Low-voltage bridge strategy to guide cryoablation of typical and atypical atrioventricular nodal re-entry tachycardia in children: mid-term outcomes in a large cohort of patients. Europace 2021; 23:271-277. [PMID: 33038208 DOI: 10.1093/europace/euaa195] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS In the current literature, results of the low-voltage bridge (LVB) ablation strategy for the definitive treatment of atrioventricular nodal re-entry tachycardia (AVNRT) seem to be encouraging also in children. The aims of this study were (i) to prospectively evaluate the mid-term efficacy of LVB ablation in a very large cohort of children with AVNRT, and (ii) to identify electrophysiological factors associated with recurrence. METHODS AND RESULTS One hundred and eighty-four children (42% male, mean age 13 ± 4 years) with AVNRT underwent transcatheter cryoablation guided by voltage mapping of the Koch's triangle. Acute procedural success was 99.2% in children showing AVNRT inducibility at the electrophysiological study. The overall recurrence rate was 2.7%. The presence of two LVBs, a longer fluoroscopy time and the presence of both typical and atypical AVNRT, were found to be significantly associated with an increased recurrence rate during mid-term follow-up. Conversely, there was no significant association between recurrences and patient's age, type of LVB, lesion length, number of cryolesions or catheter tip size. CONCLUSION The LVB ablation strategy is very effective in AVNRT treatment in children. Recurrences are related to the complexity of the arrhythmogenic substrate.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Camilla Calvieri
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Mario Salvatore Russo
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Romolo Remoli
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Vincenzo Pazzano
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Fabrizio Gimigliano
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | | | - Massimo Stefano Silvetti
- Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Palidoro-Rome, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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Drago F, Battipaglia I, Di Mambro C. Neonatal and Pediatric Arrhythmias: Clinical and Electrocardiographic Aspects. Card Electrophysiol Clin 2018; 10:397-412. [PMID: 29784491 DOI: 10.1016/j.ccep.2018.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Arrhythmias have acquired a specific identity in pediatric cardiology, but for pediatric cardiologists it has always been difficult to recognize and treat them. Changes in anatomy and physiology result in electrocardiogram features that differ from the normal adult pattern and vary according to the age of the child. Sinus arrhythmia, ectopic atrial rhythm, "wandering pacemaker," and junctional rhythm can be normal characteristics in children (15%-25% of healthy children can have these rhythms on the electrocardiogram). Tachyarrhythmias and bradyarrhythmias must be treated according to the severity of symptoms, and the patient's age and weight.
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Affiliation(s)
- Fabrizio Drago
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy.
| | - Irma Battipaglia
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy
| | - Corrado Di Mambro
- Paediatric Cardiology and Cardiac Arrhythmias Unit, Department of Paediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Piazza Sant'Onofrio 4, Rome 00165, Italy
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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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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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