Limited fluoroscopy catheter ablation of accessory pathways in children

作者：Swissa Moshe^*; Birk Einat; Dagan Tamir; Naimer Sody Abby; Fogelman Michal; Einbinder Tom; Bruckheimer Elchanan; Fogelman Rami

来源：Journal of Cardiology, 2017, 70(3-4): 382-386.

DOI：10.1016/j.jjcc.2016.12.018

• Catheter ablation
• Limited fluoroscopy
• Accessory pathway
• Wolf-Parkinson-White syndrome
• Electro-anatomic mapping systems

Background: Limited fluoroscopy ablation using 3D electro-anatomical system (3DS) has been used for arrhythmias in children, however it is not a common practice. We aimed to facilitate a fluoroscopy limited approach for ablation of accessory pathways (AP) in children.
Methods: Following electrophysiologic (EP) catheter placement a single dual-plane fluoroscopic image (right anterior oblique-30 degrees and left anterior oblique-60 degrees views) was acquired and the 3DS views were rotated to be a perfect match to the fluoroscopy. Ninety-four consecutive pediatric patients [mean age 11.8 +/- 4.1 (4.2-18) years, 61.7% males] with Wolf-Parkinson-White syndrome underwent ablation of an AP. Fifty-seven had manifest AP, 54 had left-sided AP (LSAP) and 40 had right-sided AP (RSAP).
Results: The acute success rate was 95.7% (90/94), with a recurrence rate of 1.1% (1/90) at a mean followup of 13 +/- 5.5 (4.4-22.9) months. Mean procedure and fluoroscopy times were 144 +/- 45 (55-262) min and 1.8 +/- 1.4 (0.1-5.6) min, respectively. Comparison of the first 20 procedures to the next 74 procedures demonstrated an extended procedure time (171 +/- 1 53 min vs 135 +/- 38 min, p < 0.005), however the fluoroscopy time, the number of long applications, the time to effect, and the acute success rate were similar. There were no permanent ablation-related complications.
Conclusions: A limited fluoroscopy approach for ablation of AP in children using 3DS is easily acquired, adapted, reduces the fluoroscopy time, and has an excellent efficacy and safety profile.

• 出版日期2017-10