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Fluoroless catheter ablation of accessory pathways in adult and pediatric patients: a single centre experience

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Abstract

Catheter radio-frequency ablation (RFA) and cryo-ablation (CRA) procedures are an effective and safe treatment options for adult and pediatric patients with accessory pathway (AP) mediated tachycardias. Non-fluoroscopic techniques during catheter ablation (CA) procedures reduce potentially harmful effects of radiation. Our aim was to investigate the efficacy and safety of completely fluoroless RFA and CRA procedures in pediatric and adult patients with APs. Consecutive patients with AP-related tachycardia and high risk asymptomatic ventricular pre-excitation were assessed in retrospective analysis. Three-dimensional (3D) electro-anatomical mapping (EAM) and intra-cardiac echocardiography (ICE) were used as principal imaging modalities. Fluoroscopy was not used during any stage of the procedures. Among 116 included patients (22.76 ± 16.1 years, 68 patients < 19 years), 60 had left-sided APs, 16 right-sided APs and 40 septal APs. Altogether, 96 had RFA and 20 CRA procedures. The acute success rates (ASR) of RFA and CRA were 97.9% and 95%, respectively (p = 0.43), with recurrence rates (RR) of 8.33% and 40%, respectively (p < 0.0001). The outcome difference was principally driven by lower RR with RFA in septal APs (9.1% vs. 38.9%, p = 0.025). Pediatric patients with APs (12.21 ± 3.76 years) had similar procedural parameters and outcomes compared to adult patients. There were no procedure-related complications. In adult and pediatric patients with AP-related tachycardias, both CRA and RFA can be effectively and safely performed without the use of fluoroscopy. In addition, RFA resulted in better outcomes compared to CRA.

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Availability of data and materials

Data generated or analyzed during this study is for the most part included in this published article. Additional raw data is available and can be shared upon request to the corresponding author.

Abbreviations

RFA:

Radio-frequency ablation

CRA:

Cryo-ablation

AP:

Accessory pathway

CA:

Catheter ablation

SVT:

Supra-ventricular tachycardia

ECG:

Electrocardiogram

3D EAM:

Three-dimensional electro-anatomic mapping

ICE:

Intra-cardiac echocardiography

TPT:

Total procedural time

TAT:

Total ablation time

ASR:

Acute success rate

RR:

Recurrence rate

AFSR:

Arrhythmia free survival rate

WPW:

Wolff-Parkinson-White

ALARA:

As low as reasonably achievable

AAD:

Anti-arrhythmic drug

HV:

His-ventricular

VA:

Ventriculo-atrial

AV:

Atrio-ventricular

AVRT:

Atrio-ventricular reentry tachycardia

LAT:

Local activation time

CR:

Complication rate

SD:

Standard deviation

BMI:

Body-mass index

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Acknowledgements

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Authors and Affiliations

  1. Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia

    Mehmet Yazici, Nikola Lakič, Tine Prolič Kalinšek, Katja Ažman Juvan & Matevž Jan

  2. Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia

    David Žižek

  3. Pediatric Cardiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Mirko Topalović

  4. Anesthesiology Department, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Gordan Mijovski

Authors
  1. Mehmet Yazici
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  2. Nikola Lakič
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  3. Tine Prolič Kalinšek
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  4. David Žižek
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  5. Katja Ažman Juvan
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Contributions

All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) made substantial contribution to the design of the study, acquisition, analysis and interpretation of data. All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) also actively participated in drafting the manuscript, its final revisions and corrections. All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) read and approved the final version of the manuscript. All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) agree to be personally accountable for their personal contributions to the manuscript.

Corresponding author

Correspondence to Matevž Jan.

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Conflict of interest

Matevž Jan received honoraria from Biosense Webster and Abbott. Other authors report no conflict of interests.

Ethical approval

The study complies with the Declaration of Helsinki. The fluoroless catheter ablation protocol was approved by The National Medical Ethics Committee (Komisija za medicinsko etiko Republike Slovenije).

Informed consent

All patients (or their parents in case of pediatric patients) gave written informed consent before ablation procedures were performed.

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Yazici, M., Lakič, N., Prolič Kalinšek, T. et al. Fluoroless catheter ablation of accessory pathways in adult and pediatric patients: a single centre experience. Int J Cardiovasc Imaging 37, 1873–1882 (2021). https://doi.org/10.1007/s10554-021-02168-5

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  • DOI: https://doi.org/10.1007/s10554-021-02168-5

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