Advertisement

Pediatric Cardiology

, Volume 40, Issue 1, pp 126–132 | Cite as

A Prospective Assessment of Optimal Mechanical Ventilation Parameters for Pediatric Catheter Ablation

  • Christopher M. JansonEmail author
  • Scott R. Ceresnak
  • Jaeun M. Choi
  • Anne M. Dubin
  • Kara S. Motonaga
  • Glenn E. Mann
  • Madelyn Kahana
  • Ingrid Fitz-James
  • Lisa Wise-Faberowski
  • Komal Kamra
  • Lynn Nappo
  • Anthony Trela
  • Robert H. Pass
Original Article
  • 73 Downloads

Abstract

Catheter stability, an important factor in ablation success, is affected by ventilation. Optimal ventilation strategies for pediatric catheter ablation are not known. We hypothesized that small tidal volume and positive end-expiratory pressure are associated with reduced ablation catheter movement at annular positions. Subjects aged 5–25 years undergoing ablation for supraventricular tachycardia (SVT) or WPW at two centers from March 2015 to September 2016 were prospectively enrolled and randomized to receive mechanical ventilation with either positive end-expiratory pressure of 5 cm H2O (PEEP) or 0 cm H2O (ZEEP). Movement of the ablation catheter tip at standard annular positions was measured using 3D electroanatomic mapping systems under two conditions: small tidal volume (STV) (3–5 mL/kg) or large TV (LTV) (6–8 mL/kg). 58 subjects (mean age 13.8 years) were enrolled for a total of 266 separate observations of catheter movement. STV ventilation was associated with significantly reduced catheter movement, compared to LTV at all positions (right posteroseptal: 2.5 ± 1.4 vs. 5.2 ± 3.1 mm, p < 0.0001; right lateral: 2.7 ± 1.6 vs. 6.3 ± 3.5 mm, p < 0.0001; left lateral: 1.8 ± 1.0 vs. 4.3 ± 1.9 mm, p < 0.0001). The presence or absence of PEEP had no effect on catheter movement. In multivariable analysis, STV was associated with a 3.1-mm reduction in movement (95% CI 2.6–3.5, p < 0.0001), adjusting for end-expiratory pressure, annular location, and patient size. We conclude that STV ventilation is associated with reduced ablation catheter movement compared to a LTV strategy, independent of PEEP and annular position.

Keywords

Electrophysiology Catheter ablation SVT WPW Catheter stability Ventilation 

Notes

Acknowledgements

The authors would like to acknowledge Sadiq Khan (Biosense Webster) and Christine Feller (St. Jude Medical) for their technical support during this study.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the IRBs of both Children’s Hospital at Montefiore/Albert Einstein College of Medicine and Lucile Packard Children’s Hospital/Stanford University School of Medicine.

Informed Consent

Written informed consent was obtained from all individual participants in the study. This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G (2004) Prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 1(2):188–196CrossRefGoogle Scholar
  2. 2.
    Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G (2004) Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 15(7):759–770CrossRefGoogle Scholar
  3. 3.
    Ceresnak SR, Kahana M, Zucker HA, Mann G, Nappo L, Pass RH (2014) Effects of ventilation and catheter position on catheter movement on the tricuspid annulus during ablation in children. Pacing Clin Electrophysiol 37(8):1051–1057CrossRefGoogle Scholar
  4. 4.
    Noseworthy PA, Malchano ZJ, Ahmed J, Holmvang G, Ruskin JN, Reddy VY (2005) The impact of respiration on left atrial and pulmonary venous anatomy: implications for image-guided intervention. Heart Rhythm 2(11):1173–1178CrossRefGoogle Scholar
  5. 5.
    Kumar S, Morton JB, Halloran K, Spence SJ, Lee G, Wong MC, Kistler PM, Kalman JM (2012) Effect of respiration on catheter-tissue contact force during ablation of atrial arrhythmias. Heart Rhythm 9(7):1041–1047 e1041CrossRefGoogle Scholar
  6. 6.
    Goode JS Jr, Taylor RL, Buffington CW, Klain MM, Schwartzman D (2006) High-frequency jet ventilation: utility in posterior left atrial catheter ablation. Heart Rhythm 3(1):13–19CrossRefGoogle Scholar
  7. 7.
    Pecht B, Maginot KR, Boramanand NK, Perry JC (2002) Techniques to avoid atrioventricular block during radiofrequency catheter ablation of septal tachycardia substrates in young patients. J Interv Card Electrophysiol 7(1):83–88CrossRefGoogle Scholar
  8. 8.
    Friedman PA (2012) Hitting a moving target: catheter ablation and respiration. Heart Rhythm 9(7):1048–1049CrossRefGoogle Scholar
  9. 9.
    Hutchinson MD, Garcia FC, Mandel JE, Elkassabany N, Zado ES, Riley MP, Cooper JM, Bala R, Frankel DS, Lin D, Supple GE, Dixit S, Gerstenfeld EP, Callans DJ, Marchlinski FE (2013) Efforts to enhance catheter stability improve atrial fibrillation ablation outcome. Heart Rhythm 10(3):347–353CrossRefGoogle Scholar
  10. 10.
    Goldberg CS, Caplan MJ, Heidelberger KP, Dick M (1999) The dimensions of the triangle of Koch in children. Am J Cardiol 83(1):117–120CrossRefGoogle Scholar
  11. 11.
    Vazir-Marino F, Young ML, Kohli V, Barron M, Wolff GS (1999) Controlled ventilation enhances catheter stability during radiofrequency ablation. Pacing Clin Electrophysiol 22(1):86–90CrossRefGoogle Scholar
  12. 12.
    Packer D (2005) Three-dimensional mapping in interventional electrophysiology: techniques and technology. J Cardiovasc Electrophysiol 16:1110–1116CrossRefGoogle Scholar
  13. 13.
    Beinart R, Kabra R, Heist KE, Blendea D, Barrett CD, Danik SB, Collins R, Ruskin JN, Mansour M (2011) Respiratory compensation improves the accuracy of electroanatomic mapping of the left atrium and pulmonary veins during atrial fibrillation ablation. J Interv Card Electrophysiol 32(2):105–110CrossRefGoogle Scholar
  14. 14.
    Szeplaki G, Geller L, Ozcan EE, Tahin T, Kovacs OM, Parazs N, Karady J, Maurovich-Horvat P, Szilagyi S, Osztheimer I, Toth A, Merkely B (2016) Respiratory gating algorithm helps to reconstruct more accurate electroanatomical maps during atrial fibrillation ablation performed under spontaneous respiration. J Interv Card Electrophysiol 46(2):153–159CrossRefGoogle Scholar
  15. 15.
    Eitel C, Hindricks G, Dagres N, Sommer P, Piorkowski C (2010) EnSite velocity cardiac mapping system: a new platform for 3D mapping of cardiac arrhythmias. Expert Rev Med Devices 7(2):185–192CrossRefGoogle Scholar
  16. 16.
    Saul PJ, Kanter RJ (2016) PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease: Developed in partnership with the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American Academy of Pediatrics (AAP), the American Heart Association (AHA), and the Association for European Pediatric and Congenital Cardiology (AEPC). Heart Rhythm 13(6):e251–e289CrossRefGoogle Scholar
  17. 17.
    Di Biase L, Conti S, Mohanty P, Bai R, Sanchez J, Walton D, John A, Santangeli P, Elayi CS, Beheiry S, Gallinghouse GJ, Mohanty S, Horton R, Bailey S, Burkhardt JD, Natale A (2011) General anesthesia reduces the prevalence of pulmonary vein reconnection during repeat ablation when compared with conscious sedation: results from a randomized study. Heart Rhythm 8(3):368–372CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Christopher M. Janson
    • 1
    • 6
    Email author
  • Scott R. Ceresnak
    • 2
  • Jaeun M. Choi
    • 3
  • Anne M. Dubin
    • 2
  • Kara S. Motonaga
    • 2
  • Glenn E. Mann
    • 4
  • Madelyn Kahana
    • 4
  • Ingrid Fitz-James
    • 4
  • Lisa Wise-Faberowski
    • 5
  • Komal Kamra
    • 5
  • Lynn Nappo
    • 1
  • Anthony Trela
    • 2
  • Robert H. Pass
    • 1
  1. 1.Division of CardiologyChildren’s Hospital at Montefiore/Albert Einstein College of MedicineBronxUSA
  2. 2.Division of CardiologyLucile Packard Children’s Hospital/Stanford University School of MedicinePalo AltoUSA
  3. 3.Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxUSA
  4. 4.Division of AnesthesiologyChildren’s Hospital at Montefiore/Albert Einstein College of MedicineBronxUSA
  5. 5.Division of AnesthesiologyLucile Packard Children’s Hospital/Stanford University School of MedicinePalo AltoUSA
  6. 6.Children’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations