Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-03T11:33:53.924Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of cryoablation with 3D mapping versus conventional mapping for the treatment of atrioventricular re-entrant tachycardia and right-sided paraseptal accessory pathways

Published online by Cambridge University Press:  14 September 2015

Mario S. Russo ,
Fabrizio Drago ,
Massimo S. Silvetti ,
Daniela Righi ,
Corrado Di Mambro ,
Silvia Placidi ,
Monica Prosperi ,
Michele Ciani ,
Maria T. Naso Onofrio  and
Vittorio Cannatà
Mario S. Russo
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Fabrizio Drago*
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Massimo S. Silvetti
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Daniela Righi
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Corrado Di Mambro
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Silvia Placidi
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Monica Prosperi
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Michele Ciani
Affiliation:
St. Jude Medical, Agrate Brianza, Rome, Italy
Maria T. Naso Onofrio
Affiliation:
Freelancer, Rome, Italy
Vittorio Cannatà
Affiliation:
Enterprise Risk Management, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy
*
Correspondence to: F. Drago, MD, Pediatric Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino, Rome, Italy. Tel: +39 0668593559; Fax: +39 0668593375; E-mail: fabrizio.drago@opbg.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

Transcatheter cryoablation is a well-established technique for the treatment of atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia in children. Fluoroscopy or three-dimensional mapping systems can be used to perform the ablation procedure. The aim of this study was to compare the success rate of cryoablation procedures for the treatment of right septal accessory pathways and atrioventricular nodal re-entry circuits in children using conventional or three-dimensional mapping and to evaluate whether three-dimensional mapping was associated with reduced patient radiation dose compared with traditional mapping.

Methods

In 2013, 81 children underwent transcatheter cryoablation at our institution, using conventional mapping in 41 children – 32 atrioventricular nodal re-entry tachycardia and nine atrioventricular re-entry tachycardia – and three-dimensional mapping in 40 children – 24 atrioventricular nodal re-entry tachycardia and 16 atrioventricular re-entry tachycardia.

Results

Using conventional mapping, the overall success rate was 78.1 and 66.7% in patients with atrioventricular nodal re-entry tachycardia or atrioventricular re-entry tachycardia, respectively. Using three-dimensional mapping, the overall success rate was 91.6 and 75%, respectively (p=ns). The use of three-dimensional mapping was associated with a reduction in cumulative air kerma and cumulative air kerma–area product of 76.4 and 67.3%, respectively (p<0.05).

Conclusions

The use of three-dimensional mapping compared with the conventional fluoroscopy-guided method for cryoablation of right septal accessory pathways and atrioventricular nodal re-entry circuits in children was associated with a significant reduction in patient radiation dose without an increase in success rate.

Keywords

Supraventricular tachycardiathree-dimensional mappingcryoablationchildren
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 931 - 940
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Miyazaki, A, Blaufox, AD, Fairbrother, DL, Saul, JP. Cryo-ablation for septal tachycardia substrates in pediatric patients: mid-term results. J Am Coll Cardiol 2005; 45: 581–588.Google Scholar
2. Drago, F, De Santis, A, Grutter, G, Silvetti, MS. Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients: efficacy, safety, and midterm follow-up. J Am Coll Cardiol 2005; 45: 1096–1103.Google Scholar
3. Kriebel, T, Broistedt, C, Kroll, M, Sigler, M, Paul, T. Efficacy and safety of cryoenergy in the ablation of atrioventricular reentrant tachycardia substrates in children and adolescents. J Cardiovasc Electrophysiol 2005; 16: 960–966.CrossRefGoogle ScholarPubMed
4. Drago, F, Silvetti, MS, De Santis, A, Grutter, G, Andrew, P. Lengthier cryoablation and a bonus cryoapplication is associated with improved efficacy for cryothermal catheter ablation of supraventricular tachycardias in children. J Interv Card Electrophysiol 2006; 16: 191–198.Google Scholar
5. Drago, F, Russo, MS, Silvetti, MS, De Santis, A, Naso Onofrio, MT. “Time to effect” during cryomapping: a parameter related to the long-term success of accessory pathways cryoablation in children. Europace 2009; 11: 630–634.Google Scholar
6. Drago, F, Russo, MS, Silvetti, MS, et al. Cryoablation of typical atrioventricular nodal reentrant tachycardia in children: six years’ experience and follow-up in a single center. Pacing Clin Electrophysiol 2010; 33: 475–481.CrossRefGoogle ScholarPubMed
7. LaPage, MJ, Saul, JP, Reed, JH. Long-term outcomes for cryoablation of pediatric patients with atrioventricular nodal reentrant tachycardia. Am J Cardiol 2010; 105: 1118–1121.Google Scholar
8. Czosek, RJ, Anderson, J, Marino, BS, Connor, C, Knilans, TK. Linear lesion cryoablation for the treatment of atrioventricular nodal re-entry tachycardia in pediatrics and young adults. Pacing Clin Electrophysiol 2010; 33: 1304–1311.Google Scholar
9. Drago, F, Placidi, S, Righi, D, et al. Cryoablation of AVNRT in children and adolescents: early intervention leads to a better outcome. J Cardiovasc Electrophysiol 2014; 25: 398–403.Google Scholar
10. Drago, F, Righi, D, Placidi, S, et al. Cryoablation of right-sided accessory pathways in children: report of efficacy and safety after 10-year experience and follow-up. Europace 2013; 15: 1651–1656.CrossRefGoogle ScholarPubMed
11. Ait-Ali, L, Andreassi, MG, Foffa, I, et al. Cumulative patient effective dose and acute radiation-induced chromosomal DNA damage in children with congenital heart disease. Heart 2010; 96: 269–274.Google Scholar
12. Drago, F, Silvetti, MS, Di Pino, A, et al. Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. J Cardiovasc Electrophysiol 2002; 13: 778–782.Google Scholar
13. Smith, G, Clark, JM. Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing Clin Electrophysiol 2007; 30: 510–518.CrossRefGoogle Scholar
14. Tuzcu, V. Significant reduction of fluoroscopy in pediatric catheter ablation procedures: long-term experience from a single center. Pacing Clin Electrophysiol 2012; 35: 1067–1073.Google Scholar
15. International Commission on Radiation Units and Measurements. Image quality in chest radiography. ICRU Report 74. J ICRU 2005; 5: 2.Google Scholar
16. International Electrotechnical Commission. Report 60601 Medical electrical equipment – Part 2-43: Particular requirements for the safety of X-ray equipment for interventional procedures. IEC, Geneva, Switzerland, 2010.Google Scholar
17. Gallagher, JJ, Smith, WM, Kasell, J, et al. Use of the esophageal lead in the diagnosis of mechanisms of reciprocating supraventricular tachycardia. Pacing Clin Electrophysiol 1980; 3: 440–451.Google Scholar
18. Haissaguerre, M, Warin, JF, Lemetayer, P, et al. Closed-chest ablation of retrograde conduction in patients with atrioventricular nodal reentrant tachycardia. N Engl J Med 1989; 320: 426–433.CrossRefGoogle ScholarPubMed
19. Jackman, WM, Wang, XZ, Friday, KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991; 324: 1605–1611.Google Scholar
20. Miyake, CY, Mah, DY, Atallah, J, et al. Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 2011; 8: 519–525.Google Scholar
21. International Commission on Radiological Protection. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP 2007; 37: 2–4.Google Scholar
22. United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and Effects of Ionizing Radiation. Report to the General Assembly with Scientific Annexes. United Nations, New York, 2000.Google Scholar
23. Limacher, MC, Douglas, PS, Germano, G, et al. ACC expert consensus document. Radiation safety in the practice of cardiology. American College of Cardiology. J Am Coll Cardiol 1998; 31: 892–913.Google Scholar
24. Davies, AG, Cowen, AR, Kengyelics, SM, et al. X-ray dose reduction in fluoroscopically guided electrophysiology procedures. Pacing Clin Electrophysiol 2006; 29: 262–271.Google Scholar
25. Miller, DL, et al. Radiation doses in interventional radiology procedures: The RAD-IR study part I: overall measures of dose. J Vasc Interv Radiol 2003; 14: 711–727.CrossRefGoogle ScholarPubMed