Ablation of supraventricular tachycardia in children using a limited fluoroscopy approach with the electro-anatomical system guidance

Özet

Aim: Athough, catheter ablation has become established therapy for tre-atment of pediatric SVT, X-ray has been used during electrophysiological procedures. Recent advances in electroanatomic mapping technologies resulted in a decrease or elimination of fluoroscopy during catheter abla-tion. Although, radiofrequency ablation (RFA) is a common option for tre-atment of tachyarrhythmias, it has irreversible risk of AV block. Cryoab-lation is preferred for septal tachycardia substrates due its safety. In this study, we presented our results of children who underwent SVT ablation using electroanatomical system and experiences in cryoablation.Method: A total of 48 children underwent ablation of SVT. All procedures were performed using the EnSite System (St. Jude Medical, Inc., St. Paul, MN, USA).Results: Thirty patients had AVNRT, one of these had an additional atrial tachycardia and the other one had atypical AVRNT, 7 had concealed AP, 9 had manifest AP, 2 had atrial tachycardia, and one had Mahaim AP. Fluoroscopy was not used in 42 patients (87.5%). The mean fluoroscopy time in the remaining 6 (12.5%) patients was 6.0±2.28 minutes.Cryoab-lation was used in 34 (70.8%) and RFA in 14 (29.2%). Acute success was 9A5.8%. During follow-up of duration, SVT recurred in 3 patients (6.2%). These patients underwent second successful ablation procedures. Final success was 100 %. No permanent AV block was observed. An uneventful pericardial needle injury occured in one patient during transseptal punc-ture with minimal effusion.Conclusions: Catheter ablation of SVT can be performed effectively with limited fluoroscopy approach. Cryoablation should be preferred for abla-tion of septal tachycardia substrates, including AVNRT.