Abstract
Background
Cryoablation of APs localized near the atrioventricular (AV) junction is a well-established ablation strategy in children, and it has proved to be very safe. However, recurrence rates remain considerable for specific accessory pathway (AP) localizations. The aim of this retrospective study was to evaluate the efficacy and safety of a trans-jugular approach for cryoablation of right anterior, anterior-lateral, and anterior-septal APs in children, as compared to the conventional femoral approach.
Methods
From June 2019 to November 2023, 24 consecutive patients (mean age 13.2 ± 4.6, 12 males (50% of total cohort)) with right anterior-lateral, anterior, and anterior-septal/para-Hisian APs underwent 3D non-fluoroscopic transcatheter cryoablation through the right jugular vein at our Institution. Ablation results were compared with 24 patients for whom a conventional trans-femoral approach was used.
Results
Acute procedural success rate was 100% (n = 24/24), with a non-statistically significant difference as compared to the control group (100% vs. 83%, p = 0.1).
During follow-up (1.1 years, interquartile range 0.6–1.3), one patient (4%) had a recurrence in the trans-jugular group, as opposed to eight (38%) in the control group (p = 0.006). No permanent complications occurred.
Conclusions
3D cryoablation of right anterior-lateral, anterior, and anterior-septal/para-Hisian APs in children using a trans-jugular approach is extremely effective and safe, resulting in higher chronic success rate compared to the conventional femoral approach.
Graphical abstract
In children, acute success rate of cryoablation of anterior and para-Hisian accessory pathways via the trans-jugular approach was similar to trans-femoral approach (p = 0.1), but recurrences were significantly lower (p = 0.006).
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Data availability
The data underlying this article will be shared on reasonable request to the corresponding author.
References
S. P. Seslar et al., “The multicenter pediatric and adult congenital EP quality (MAP-IT) initiative-rationale and design: report from the Pediatric and Congenital Electrophysiology Society’s MAP-IT Taskforce,” Congenit Heart Dis, p. n/a-n/a, Jun. 2013, https://doi.org/10.1111/chd.12084.
Kovach JR, et al. Outcomes of catheter ablation of anteroseptal and midseptal accessory pathways in pediatric patients. Heart Rhythm. 2020;17(5):759–67. https://doi.org/10.1016/j.hrthm.2019.12.008.
Miyazaki A, Blaufox AD, Fairbrother DL, Saul JP. Cryo-ablation for septal tachycardia substrates in pediatric patients. J Am Coll Cardiol. 2005;45(4):581–8. https://doi.org/10.1016/j.jacc.2004.10.051.
El-Assaad I, et al. Accessory pathway ablation in Ebstein anomaly: a challenging substrate. Heart Rhythm. 2021;18(11):1844–51. https://doi.org/10.1016/j.hrthm.2021.06.1171.
G. Mitacchione, R. Marazzi, L. Doni, J. Marazzato, and R. de Ponti, “Cryoablation of para-Hisian and mid-septal accessory pathways: long-term outcomes of a specific stepwise cryoablation protocol,” Miner Cardiol Angiol, vol. 71, no. 3, May 2023, https://doi.org/10.23736/S2724-5683.22.06136-1.
Virk K, Stecker E, Balaji S. Cryoablation to improve catheter stability and ablation success in the right atrioventricular groove. Indian Pacing Electrophysiol J. 2021;21(5):269–72. https://doi.org/10.1016/j.ipej.2021.07.001.
Drago F, et al. 3D non-fluoroscopic cryoablation of right-sided accessory pathways in children: monocentric study and literature review. Congenit Heart Dis. 2021;16(6):561–72. https://doi.org/10.32604/CHD.2021.016623.
Drago F, 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(11):1651–6. https://doi.org/10.1093/europace/eut122.
Drago F. Paediatric catheter cryoablation: techniques, successes and failures. Curr Opin Cardiol. 2008;23(2):81–4. https://doi.org/10.1097/HCO.0b013e3282f39891.
Ergül Y, et al. The transjugular approach: an alternative route to improve ablation success in right anteriorly and anterolaterally-located supraventricular tachycardia substrates in children. Pediatr Cardiol. 2019;40(3):477–82. https://doi.org/10.1007/s00246-018-1987-4.
Salem YS, Burke MC, Kim SS, Morady F, Knight BP. Slow pathway ablation for atrioventricular nodal reentry using a right internal jugular vein approach: a case series. Pacing Clin Electrophysiol. 2006;29(1):59–62. https://doi.org/10.1111/j.1540-8159.2006.00292.x.
M. Emmel, K. Brockmeier, and N. Sreeram, “Combined transhepatic and transjugular approach for radiofrequency ablation of an accessory pathway in a child with complex congenital heart disease,” Zeitschrift fur Kardiologie, vol. 93, no. 7, Jul. 2004, https://doi.org/10.1007/s00392-004-0090-4.
Ramos-Maqueda J, et al. Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias. Revista Española de Cardiología (English Edition). 2022;75(2):166–73. https://doi.org/10.1016/j.rec.2020.11.024.
Fukuzawa K, Takahara H, Suzuki Y, Hirata K. Trans-jugular vein approach for ablation of ventricular premature contractions originating from the tricuspid annulus. Indian Pacing Electrophysiol J. 2023;23(1):23–6. https://doi.org/10.1016/j.ipej.2022.10.001.
Katritsis DG, et al. European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulación Cardiaca y Electrofisiologia (SOLAECE). EP Europace. 2017;19(3):465–511. https://doi.org/10.1093/europace/euw301.
Brugada J, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020;41(5):655–720. https://doi.org/10.1093/eurheartj/ehz467.
Brugada J, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. EP Europace. 2013;15(9):1337–82. https://doi.org/10.1093/europace/eut082.
Philip Saul J, et al. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm. 2016;13(6):e251–89. https://doi.org/10.1016/j.hrthm.2016.02.009.
Santangeli P, Kodali S, Liang JJ. How to perform left atrial transseptal access and catheter ablation of atrial fibrillation from a superior approach. J Cardiovasc Electrophysiol. 2020;31(1):293–9. https://doi.org/10.1111/jce.14294.
Troianos CA, et al. Guidelines for performing ultrasound guided vascular cannulation. Anesth Analg. 2012;114(1):46–72. https://doi.org/10.1213/ANE.0b013e3182407cd8.
Drago F, Russo MS, Silvetti MS, De Santis A, NasoOnofrio MT. Time to effect’ during cryomapping: a parameter related to the long-term success of accessory pathways cryoablation in children. Europace. 2009;11(5):630–4. https://doi.org/10.1093/europace/eup045.
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. J Am Coll Cardiol. 2005;45(7):1096–103. https://doi.org/10.1016/j.jacc.2004.12.048.
Telishevska M, et al. Catheter ablation in ASymptomatic PEDiatric patients with ventricular preexcitation: results from the multicenter ‘CASPED’ study. Clin Res Cardiol. 2019;108(6):683–90. https://doi.org/10.1007/s00392-018-1397-x.
Mandapati R, Berul CI, Triedman JK, Alexander ME, Walsh EP. Radiofrequency catheter ablation of septal accessory pathways in the pediatric age group. Am J Cardiol. 2003;92(8):947–50. https://doi.org/10.1016/S0002-9149(03)00975-5.
Pappone C, et al. Wolff-Parkinson-White syndrome in the era of catheter ablation. Circulation. 2014;130(10):811–9. https://doi.org/10.1161/CIRCULATIONAHA.114.011154.
Strauss KJ, Kaste SC. The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients—a white paper executive summary. Pediatr Radiol. 2006;36(S2):110. https://doi.org/10.1007/s00247-006-0184-4.
Russo MS, et al. Comparison of cryoablation with 3D mapping versus conventional mapping for the treatment of atrioventricular re-entrant tachycardia and right-sided paraseptal accessory pathways. Cardiol Young. 2016;26(5):931–40. https://doi.org/10.1017/S1047951115001614.
Brugada Josep, Mont L, Bolao IG, Figueiredo M, Matas M, Navarro-López F. Radiofrequency ablation of anteroseptal, para-Hisian, and mid-septal accessory pathways using a simplified femoral approach. Pacing Clin Electrophysiol. 1998;21(4):735–41. https://doi.org/10.1111/j.1540-8159.1998.tb00131.x.
Wood MA, et al. Determinants of lesion sizes and tissue temperatures during catheter cryoablation. Pacing Clin Electrophysiol. 2007;30(5):644–54. https://doi.org/10.1111/j.1540-8159.2007.00726.x.
Parvez B, Pathak V, Schubert CM, Wood M. Comparison of lesion sizes produced by cryoablation and open irrigation radiofrequency ablation catheters. J Cardiovasc Electrophysiol. 2008;19(5):528–34. https://doi.org/10.1111/j.1540-8167.2007.01072.x.
DiLorenzo MP, Pass RH, Nappo L, Ceresnak SR. Ablating the anteroseptal accessory pathway-ablation via the right internal jugular vein may improve safety and efficacy. J Interv Card Electrophysiol. 2012;35(3):293–9. https://doi.org/10.1007/s10840-012-9699-9.
M. Liang et al., “Different approaches for catheter ablation of para-Hisian accessory pathways,” Circ Arrhythm Electrophysiol, vol. 10, no. 6, Jun. 2017, https://doi.org/10.1161/CIRCEP.116.004882.
Park J, et al. Prevalence, risk, and benefits of radiofrequency catheter ablation at the aortic cusp for the treatment of mid to anteroseptal supra-ventricular tachyarrhythmias. Int J Cardiol. 2013;167(3):981–6. https://doi.org/10.1016/j.ijcard.2012.03.082.
Sacher F, et al. Wolff-Parkinson-White ablation after a prior failure: a 7-year multicentre experience. Europace. 2010;12(6):835–41. https://doi.org/10.1093/europace/euq050.
Corcia MCG, et al. Redo accessory pathway ablation in the pediatric population. J Interv Card Electrophysiol. 2022;63(3):639–49. https://doi.org/10.1007/s10840-021-01064-1.
Acknowledgements
The authors would like to thank Dr. Elisa Del Vecchio for her valuable collaboration in the editorial revision. Our Centre is a healthcare provider of the European Reference Network (ERN) GUARD-Heart.
Funding
This work was supported by the Italian Ministry of Health with “Current Research funds” (202003_FBG_DRAGO).
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The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. The research protocol was approved by the locally appointed ethics committee.
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Drago, F., Flore, F., Tamborrino, P.P. et al. Trans-jugular approach for safe and successful cryoablation of para-Hisian/anterior-septal, anterior, and anterior-lateral accessory pathways in children. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01807-w
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DOI: https://doi.org/10.1007/s10840-024-01807-w