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 (original) (raw)
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Circulation-arrhythmia and Electrophysiology, 2016
C atheter ablation of the slow conducting pathway (SP) of the atrioventricular (AV) node is the recommended treatment for AV nodal reentrant tachycardia (AVNRT) in children and adults. With both radiofrequency and cryoenergy, high procedural success rates of 98% to 100% have been reported. 1,2 In adult patients, freedom from AVNRT has been achieved in 95% after radiofrequency ablation and in 90% after the use of cryoenergy 1 year after the initial ablation procedure. 3 In children and adolescents, data from the pediatric radiofrequency catheter ablation registry acquired more than a decade ago reported a significant number of recurrences with 71% freedom from AVNRT 3 years post ablation. 4 However, recent follow-up studies of pediatric patients after AVNRT ablation reported freedom from AVNRT between 84% and 100% with radiofrequency 2,5 and between 78% and 93% with cryoenergy, 6-8 respectively. These studies on a limited number of pediatric patients analyzed data on the follow-up of 1 to 3 years post ablation. Little information on the course beyond 3 years after AVNRT ablation in pediatric patients has been published. The purpose of the present study was to evaluate the longterm course of pediatric patients after AVNRT ablation at our institution. Foci of interest were (1) impact of the primary procedural end point (SP ablation versus SP modulation) on long-term success, (2) impact of body weight on long-term safety and success, (3) incidence and timing of late AVNRT recurrence, and (4) incidence of late AV block or new tachyarrhythmias attributable to AVNRT ablation. See Editorial by Kirsh Methods Patients Between October 2002 and May 2014, a total of 249 children and adolescents <18 years of age had undergone catheter ablation for AVNRT at our institution. Procedural data and primary success rates and acute complications have recently been published. 1 Patients, in whom AVNRT ablation failed (n=5), were not enrolled into the present study: although a repeat ablation was offered for all 5 subjects with procedural failure, 3 out of 5 patients were lost during follow-up and 1 individual decided against a repeat procedure. Additionally, 3 patients with permanent AV block immediately after radiofrequency ablation (n=3) 1 were excluded. Finally, follow-up data ≥1 year after AVNRT ablation of 241 patients were included into this study. Follow-up data of patients after primary AVNRT ablation procedures were exclusively considered to avoid bias by including follow-up
Catheter Ablation of Pediatric Atrioventricular Nodal Re-entrant Tachycardia
Journal of Innovations in Cardiac Rhythm Management, 2020
Catheter ablation is considered as the standard treatment for all patients with symptomatic drug-refractory tachyarrhythmia. The safety and efficacy of the procedure in the adult population is well-established. Due to the small size of the patient and difficulty in attaining venous access, infants are rarely subjected to radiofrequency ablation. Here, we report a case of drug-refractory AV nodal re-entrant tachycardia in a two-year-old child. Radiofrequency ablation was performed with a 5-Fr sized medium-curve ablation catheter deployed at the slow pathway region where a fractionated A-wave with slow-pathway potential was recorded. After ablation, no recurrence of SVT at the end of 12 months of follow-up was observed.
Cardiology, 2009
The slow pathway radiofrequency ablation is effective method of treatment in children with atrioventricular nodal reentrant tachycardia. The aim of our study was to evaluate anterograde conduction properties in children after the slow pathway ablation, to determine the efficacy and safety of this method. Material and methods: Noninvasive transesophageal electrophysiological investigation was performed in 30 patients at the follow up period (mean duration 3.24 years) after the slow pathway radiofrequency ablation. Results: The slow pathway function was observed in 13 patients 1 day after ablation, in 26 patients at the follow up period, and in 28 patients after atropine sulfate. Atrioventricular node conduction decreased significantly (P<0.001) the following day after ablation to 165.2 (30.2) bmp and at the follow up to 146.3 (28.5) bpm versus the preablation 190.9 (31.4) bpm. The atrioventricular node effective refractory period prolonged significantly (P<0.001) the following day after ablation to 319.3 (55.3) msec and at the follow up to 351.0 (82.1) msec versus the preablation 248.3 (36.6) msec. Fast pathway effective refractory period prolonged significantly (P=0.005): 481.2 (132.9) msec in comparison with preablation 408.0 (60.4) msec. The prolongation of the slow pathway effective refractory period was more significant (P< 0.001) than the fast pathway effective refractory period at the follow up. Two late recurrences occured, one patient had atrial tachycardia. Conclusion: Anterograde conduction did not changed significantly after long term follow up. The end-point during slow pathway ablation should be the abolition of tachycardia with preservation of dual atrioventricular nodal physiology.
The Journal of innovations in cardiac rhythm management, 2022
Catheter ablation of the slow pathway to the atrioventricular node is generally a safe and effective treatment for atrioventricular nodal re-entry tachycardia (AVNRT). However, congenital anomalies of the inferior vena cava and superior draining veins can limit traditional catheter approaches to the right heart from femoral venous access and distort local anatomy within the triangle of Koch, necessitating alternative electrophysiology (EP) mapping and ablation strategies. Despite the widespread availability of non-fluoroscopic 3-dimensional imaging systems, many providers still rely on venography to describe unusual cardiovascular anatomy and fluoroscopy to position EP catheters when mapping and ablating the slow pathway. Herein, we report our experience with a pediatric patient with inducible AVNRT and atypical venous anatomy in whom slow pathway ablation was performed successfully without the use of fluoroscopy. In addition, we describe the modification of a novel mapping technique for targeting the slow pathway for ablation.
Europace, 2009
To compare recurrence rate and other procedural characteristics in patients undergoing atrioventricular nodal re-entrant tachycardia (AVNRT) treatment with catheter cryoablation (CRYO) delivered by 6 mm-tip catheter or radiofrequency (RF) ablation. Methods and results This is a retrospective case-control study including 80 patients with AVNRT treated with CRYO from March 2002 to June 2008. They were compared with another 80 consecutive patients who underwent RF ablation for AVNRT within the same period. Procedural success of 97.5 and 95% were achieved in CRYO and RF group, respectively. There was no permanent atrioventricular block (AVB) in the CRYO group, whereas two (2.5%) patients developed permanent first-degree or second-degree AVB in RF group (P ¼ 0.155). Higher recurrence was found in the CRYO group (9 vs. 1.3%; P ¼ 0.032) with no difference in the composite endpoint of procedural failure and recurrence between the groups (P ¼ 0.263). There was significantly shorter fluoroscopy time (18.6 + 10.8 vs. 25.9 + 17.0 min; P ¼ 0.002) and more energy applications required (3.1 + 1.7 vs. 1.9 + 1.1; P , 0.001) in the CRYO than the RF group. Conclusion Compared with RF ablation, CRYO with 6 mm-tip catheter for treating AVNRT results in higher recurrence and potentially lower incidence of permanent AVB. Fluoroscopy time has been shown to be reduced by CRYO.
Europace, 2007
Aims Within the last several years, transvenous cryo-ablation has become an alternative method to perform ablation of the slow-pathway. This study evaluated the acute and long-term safety and effectiveness of atrio-ventricular nodal re-entrant tachycardia (AVNRT) cryo-ablation. Methods and results The first 69 consecutive patients with AVNRT (60 slow-fast, 4 fast-slow, and 5 slow-slow) who underwent slow-pathway cryo-ablation were included. Mean age was 37 + 15, body weight 68 + 14 kg, symptom duration 125 + 104 months, and number of ineffective antiarrhythmic (AA) drugs 1.8 + 1.4. A 7 Fr cryo-catheter (Cryocath Âw ) was used, with initially 4-mm-tip and later with 6-mm-tip electrode. Cryo-mapping (n ¼ 7.9 + 8.4 per pt) was performed at the temperature of 2308C to test the effect on the target ablation site. Successful cryo-mapping was defined as abolition of nodal conduction jump or AV nodal refractory period prolongation. Cryo-ablation (n ¼ 5.1 + 4.9 per pt) was then applied by freezing to 2758C for 4 min in duration if no AV-block occurred. Acute procedural success (defined as AVNRT non-inducibility) after the first cryo-ablation attempt was achieved in 60/69 patients (87%). During cryo-ablation, inadvertent transient AV-block was encountered in 14 patients (five I AV-block and nine II-III AV-block). A mid-septal target site was the only variable correlated with inadvertent AV-block occurrence during cryo-ablation (P , 0.02). Long-term clinical success after cryo-ablation was globally achieved in 56/66 (85%) with a mean follow-up of 18+9 months (3 pts dropped-out). After the first procedure, 41/66 (62%) had no relapse, eight had a dramatic reduction in AVNRT duration-frequency and considered themselves cured, and five needed previously ineffective AA (with no relapse in three, drastic reduction in AVNRT duration-frequency in two). The five last patients needed one or more procedures, after which one had no recurrence and one had reduction in duration-frequency. Absence of recurrence after the first procedure was positively correlated with 6-mm-tip cryo-catheter use (,0.001) and negatively with acute procedural success (,0.001). At multivariate analysis, both were independently significant (,0.04 and ,0.008, respectively). Long-term clinical success was correlated only with 6-mm-tip cryo-catheter use (,0.001).
OBJECTIVES We sought to describe the early pediatric experience of transcatheter cryoablation, and identify whether specific arrhythmia substrates and/or ablation locations were particularly suited to cryoablation. BACKGROUND Radiofrequency (RF) ablation has become established therapy for pediatric tachyarrhythmias. However, challenges remain in terms of the safety and efficacy of RF ablation in specific locations; new methods may address these issues. METHODS Prospective data were available for 64 patients age 13 4 (mean SD) years undergoing cryoablation at 14 centers participating in the Cryocath International Patient Registry. Dysrhythmia duration was 5.0 4.2 years, with diagnoses of atrioventricular node re-entrant tachycardia (AVNRT) (n 30), anteroseptal (n 11), midseptal (n 5), or other (n 15) accessory pathway (AP) mediated AV re-entry, ventricular tachycardia (VT) (n 3), and ectopic atrial tachycardia (EAT) (n 2). Two patients had more than one arrhythmia substrate. Transcatheter cryoablation was offered by cardiologist preference after written informed procedural consent of each patient and/or legal guardian. Cryomapping was performed at 30°C and cryoablation was delivered with 4-min applications at 75°C. RESULTS Acute success was achieved in 45 of 65 (69%) cryoablation patients, with best success rates in AVNRT (83%) and right septal AP (75%), and lower success rates in other AP (43%), VT (66%), and EAT (0%). No device-related adverse events were reported. The success of radiofrequency (RF) ablation applied in 14 cryoablation failures was 4 of 4 for AVNRT patients, 1 of 1 for anteroseptal AP patients, 5 of 6 for other AP patients, 0 of 1 for VT patients, and 0 of 2 for EAT patients. CONCLUSIONS Transcatheter cryoablation is a safe and well-tolerated alternative to RF ablation in pediatric patients on the basis of our initial experience. Success is highest in AVNRT and in substrates recognized as technically challenging or risky for RF ablation. (J Am Coll Cardiol 2005;45: 133– 6)