Transcatheter Cryoablation of Tachyarrhythmias in Children Initial Experience From an International Registry (original) (raw)
Related papers
Transcatheter cryoablation of tachyarrhythmias in children
Journal of the American College of Cardiology, 2005
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.
Journal of Interventional Cardiac Electrophysiology, 2006
Introduction Cryoablation is an effective treatment for children with supraventricular tachycardias (SVT). The present study documents the effect of two different cryoablation protocols on acute and chronic success rates. Methods and results Fifty-three consecutive patients (age range, 5-20 years) were treated; patients 1 to 17 were treated by a standard ablation protocol and patients 18 to 53 were treated by a modified ablation protocol that required lengthier cryoablations plus delivery of a bonus cryoapplication to consolidate the acutely successful irreversible lesion created at intervention. Electrophysiological study (EPS) was performed with diagnostic catheters and cryoablations were performed with a 7FR 4 mm tip catheter (CryoCath Technologies). Acute endpoints for non-inducibility of atrioventricular nodal re-entrant tachycardia (AVNRT) by programmed atrial stimulation at baseline or during isoproterenol performed 30 min post procedure, as well as non-inducibility and conduction block over the accessory pathway (AP). The chronic endpoint was arrhythmia recurrence post intervention. No permanent cryo-related complications or adverse outcomes were reported. Acute success rates for patients 1 to 17 and 18 to 53 were 88 and 100%, respectively. The cumulative percentage of patients without arrhythmia recurrence at 12 month follow-up was significantly different at 73 and 90%, respectively. Conclusions Lengthier cryoablation delivery, approximating 7 min per cryoablation, increases the acute success rate at intervention. Moreover, these lengthier cryoablation deliveries plus a bonus cryoapplication to consolidate the acutely successful irreversible lesion created at intervention may also significantly improve the chronic success rate, while also maintaining an excellent safety profile for cryoablation treatment of children with SVT such as AVNRT and AP located near the AV junction.
Cryoballoon ablation of the right atrial appendage to treat tachycardia in a pediatric patient
Progress in Pediatric Cardiology, 2019
Catheter ablation to treat atrial tachycardia originating in the atrial appendages can be challenging due to complex anatomy and concerns for myocardial perforation. When conventional endocardial ablation is unsuccessful or patients have recurrent tachycardia, alternative approaches may be entertained, including an epicardial transcatheter approach or surgical isolation or resection of the atrial appendage. Endocardial cryoballoon ablation is commonly used in adults with atrial fibrillation to electrically isolate the pulmonary veins, and has been extended to isolate the left atrial appendage to improve outcomes in these patients. There are limited reports using cryoballoon ablation to treat adults with non-fibrillation tachycardia originating in atrial appendages, and none in children. In this report, we describe our experience using cryoballoon ablation to electrically isolate the right atrial appendage to treat a pediatric patient with recurrent atrial tachycardia following 2 previous catheter ablation procedures.
Heart Rhythm, 2004
OBJECTIVE To study the safety, efficacy, and mapping utility of a new cryoablation catheter. BACKGROUND The CryoCath Technologies Freezor catheter has been used successfully for cryoablation of supraventricular tachycardia (SVT), but has not been evaluated in a large clinical trial. METHODS A multicenter clinical trial to evaluate the safety, efficacy, and cryomapping utility of this cryoablation catheter was conducted in 166 subjects. The target of ablation was the slow pathway in patients with SVT due to AV nodal reentry (AVNRT, n ϭ 103), an accessory pathway in patients with AV reentrant SVT (AVRT, n ϭ 51) and the AV junction in patients with atrial fibrillation (AF, n ϭ 12). RESULTS Acute procedural success (APS) was achieved in 83% of the overall group (95% CI, 76% to 88%). APS in the AVNRT group was 91% (98.3% CI, 82% to 97%), compared to 69% for AVRT (98.3% CI, 51% to 84%) and 67% for AF (98.3% CI, 29% to 93%), a highly significant difference (P Ͻ .001 by stepwise logistic regression). In patients with APS, long-term success after 6 months was 91% overall (95% CI, 86% to 96%) and 94% for AVNRT subjects (98.3% CI, 87% to 100%). None of the AVNRT or AVRT subjects required a permanent pacemaker. Cryomapping successfully identified ablation targets in 64% of patients in whom it was attempted. The electrophysiologic effects of cryomapping were completely reversible within minutes in 94% of such attempts. CONCLUSIONS Catheter cryoablation of SVT is a safe alternative to RF ablation and is clinically effective in patients with AVNRT. Cryomapping can reversibly identify targets for ablation and can help minimize the risk of inadvertent AV block during ablation.
EP Europace, 2020
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...
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).