Advertisement

Incidence of Echocardiographic Abnormalities Following Pediatric SVT Ablation: Comparison of Cases Utilizing Fluoroscopy Alone to Cases with Adjunctive 3D Electroanatomic Mapping

  • Ari J. Gartenberg
  • Robert H. Pass
  • Scott Ceresnak
  • Lynn Nappo
  • Christopher M. Janson
Original Article

Abstract

There are few data on the incidence of echocardiographic (echo) abnormalities following catheter ablation in children in the era of 3D mapping. Wide practice variation exists regarding routine post-ablation echo. We hypothesized a low incidence of clinically significant echo abnormalities following SVT ablation in otherwise healthy children. Single center data from 2009 to 2015 were reviewed; routine post-ablation echo was standard practice. Cases were categorized as utilizing fluoroscopy alone (FLUORO) or 3D mapping with a low fluoroscopic protocol (CARTO3). Congenital heart disease was excluded. Outcomes of interest included new valvular abnormalities, pericardial effusions, and wall motion abnormalities. Findings were compared to baseline studies when available and classified as normal/unchanged, clinically insignificant, or clinically significant. Outcomes were compared between FLUORO and CARTO3 groups. Of 347 ablations, 319 (92%) underwent post-procedural echo: 57% male; 55% FLUORO; mean age 13.4 ± 3.6 years. The most common ablation target was an accessory pathway (AP) in 66% (n = 144 WPW, 66 concealed), followed by AVNRT in 32% (n = 102). Radiofrequency (RF) energy was utilized in 82% (n = 262). Post-ablation echos were normal in 81% (n = 259). Clinically insignificant findings were seen in 18% (n = 58), most commonly trivial-small pericardial effusions in 11% (n = 34). Two significant findings required additional follow-up or treatment. There were no cases of wall motion abnormalities or clinically significant effusions. There were no differences in frequency of echo abnormalities between the FLUORO and CARTO3 groups. Clinically significant echocardiographic abnormalities are rare following SVT ablation in children with structurally normal hearts, independent of the use of 3D mapping.

Keywords

Supraventricular tachycardia (SVT) Catheter ablation Fluoroscopy 3D electroanatomic mapping Echocardiogram 

Notes

Funding

This research did not receive any financial support from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Informed Consent

Due to the retrospective nature of the study, formal consent is not required. This study was approved by the IRB of Children’s Hospital at Montefiore/Albert Einstein College of Medicine.

References

  1. 1.
    Kugler JD, Danford DA, Deal BJ, Gillette PC, Perry JC, Silka MJ, Van Hare GF, Walsh EP (1994) Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. N Engl J Med 330(21):1481–1487.  https://doi.org/10.1056/NEJM199405263302103 CrossRefPubMedGoogle Scholar
  2. 2.
    Kugler JD, Danford DA, Houston K, Felix G (1997) Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 80(11):1438–1443CrossRefGoogle Scholar
  3. 3.
    Kugler JD, Danford DA, Houston KA, Felix G (2002) Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 13(4):336–341CrossRefGoogle Scholar
  4. 4.
    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):188–196.  https://doi.org/10.1016/j.hrthm.2004.03.067 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    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):759–770.  https://doi.org/10.1046/j.1540-8167.2004.03645.x CrossRefPubMedGoogle Scholar
  6. 6.
    Philip Saul J, Kanter RJ, Writing C et al (2016) PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 13(6):e251–e289.  https://doi.org/10.1016/j.hrthm.2016.02.009 CrossRefPubMedGoogle Scholar
  7. 7.
    Miyake CY, Mah DY, Atallah J, Oikle HP, Melgar ML, Alexander ME, Berul CI, Cecchin F, Walsh EP, Triedman JK (2011) Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 8(4):519–525.  https://doi.org/10.1016/j.hrthm.2010.12.022 CrossRefPubMedGoogle Scholar
  8. 8.
    Gellis LA, Ceresnak SR, Gates GJ, Nappo L, Pass RH (2013) Reducing patient radiation dosage during pediatric SVT ablations using an “ALARA” radiation reduction protocol in the modern fluoroscopic era. Pacing Clin Electrophysiol 36(6):688–694.  https://doi.org/10.1111/pace.12124 CrossRefPubMedGoogle Scholar
  9. 9.
    Ceresnak SR, Dubin AM, Kim JJ, Valdes SO, Fishberger SB, Shetty I, Zimmerman F, Tanel RE, Epstein MR, Motonaga KS, Capone CA, Nappo L, Gates GJ, Pass RH (2015) Success rates in pediatric WPW ablation are improved with 3-dimensional mapping systems compared with fluoroscopy alone: a multicenter study. J Cardiovasc Electrophysiol 26(4):412–416.  https://doi.org/10.1111/jce.12623 CrossRefPubMedGoogle Scholar
  10. 10.
    Pass RH, Gates GG, Gellis LA, Nappo L, Ceresnak SR (2015) Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO(R) 3 in concert with “ALARA” principles profoundly lowers total dose. Cardiol Young 25(5):963–968.  https://doi.org/10.1017/S1047951114001474 CrossRefPubMedGoogle Scholar
  11. 11.
    Pires LA, Huang SK, Wagshal AB, Mazzola F, Young PG, Moser S (1996) Clinical utility of routine transthoracic echocardiographic studies after uncomplicated radiofrequency catheter ablation: a prospective multicenter study. The Atakr Investigators Group. Pacing Clin Electrophysiol 19(10):1502–1507CrossRefGoogle Scholar
  12. 12.
    Schaer BA, Maurer A, Sticherling C, Buser PT, Osswald S (2009) Routine echocardiography after radiofrequency ablation: to flog a dead horse? Europace 11(2):155–157.  https://doi.org/10.1093/europace/eun360 CrossRefPubMedGoogle Scholar
  13. 13.
    Kammeraad JA, Sreeram N, van Driel V, Oliver R, Balaji S (2004) Is routine echocardiography valuable after uncomplicated catheter ablation in children? Cardiol Young 14(4):386–388.  https://doi.org/10.1017/S1047951104004068 CrossRefPubMedGoogle Scholar
  14. 14.
    Amdani SM, Sallaam S, Karpawich PP, Aggarwal S (2017) Utility of echocardiography in detecting silent complications after pediatric catheter ablations. Pediatr Cardiol 38(7):1426–1433.  https://doi.org/10.1007/s00246-017-1680-z CrossRefPubMedGoogle Scholar
  15. 15.
    Van Hare GF, Colan SD, Javitz H, Carmelli D, Knilans T, Schaffer M, Kugler J, Byrum CJ, Saul JP (2007) Prospective assessment after pediatric cardiac ablation: fate of intracardiac structure and function, as assessed by serial echocardiography. Am Heart J 153(5):815–820.  https://doi.org/10.1016/j.ahj.2007.02.009 820 e811-816.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Page RL, Joglar JA, Caldwell MA et al (2016) 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the american college of cardiology/american heart association task force on clinical practice guidelines and the heart rhythm society. Circulation 133(14):e506–e574.  https://doi.org/10.1161/CIR.0000000000000311 CrossRefPubMedGoogle Scholar
  17. 17.
    Dechert BE, Dick MII, Bradley DJ, LaPage MJ (2017) Variation in pediatric post-ablation care: a survey of the pediatric and congenital electrophysiology society (PACES). Pediatr Cardiol 38(6):1257–1261.  https://doi.org/10.1007/s00246-017-1654-1 CrossRefPubMedGoogle Scholar
  18. 18.
    Saul JP, Hulse JE, Papagiannis J, Van Praagh R, Walsh EP (1994) Late enlargement of radiofrequency lesions in infant lambs. Implications for ablation procedures in small children. Circulation 90(1):492–499CrossRefGoogle Scholar
  19. 19.
    Schaffer MS, Gow RM, Moak JP, Saul JP (2000) Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry). Participating members of the Pediatric Electrophysiology Society. Am J Cardiol 86(6):639–643CrossRefGoogle Scholar
  20. 20.
    Blaufox AD, Saul JP (2004) Acute coronary artery stenosis during slow pathway ablation for atrioventricular nodal reentrant tachycardia in a child. J Cardiovasc Electrophysiol 15(1):97–100.  https://doi.org/10.1046/j.1540-8167.2004.03378.x CrossRefPubMedGoogle Scholar
  21. 21.
    Chatelain P, Zimmermann M, Weber R, Campanini C, Adamec R (1995) Acute coronary occlusion secondary to radiofrequency catheter ablation of a left lateral accessory pathway. Eur Heart J 16(6):859–861CrossRefGoogle Scholar
  22. 22.
    Pons M, Beck L, Leclercq F, Ferriere M, Albat B, Davy JM (1997) Chronic left main coronary artery occlusion: a complication of radiofrequency ablation of idiopathic left ventricular tachycardia. Pacing Clin Electrophysiol 20(7):1874–1876CrossRefGoogle Scholar
  23. 23.
    Schneider HE, Kriebel T, Gravenhorst VD, Paul T (2009) Incidence of coronary artery injury immediately after catheter ablation for supraventricular tachycardias in infants and children. Heart Rhythm 6(4):461–467.  https://doi.org/10.1016/j.hrthm.2009.01.029 CrossRefPubMedGoogle Scholar
  24. 24.
    Minich LL, Snider AR, Dick MII (1992) Doppler detection of valvular regurgitation after radiofrequency ablation of accessory connections. Am J Cardiol 70(1):116–117CrossRefGoogle Scholar
  25. 25.
    Redd C, Thomas C, Willis M, Amos M, Anderson J (2017) Cost of Unnecessary testing in the evaluation of pediatric syncope. Pediatr Cardiol 38(6):1115–1122.  https://doi.org/10.1007/s00246-017-1625-6 CrossRefPubMedGoogle Scholar
  26. 26.
    Chamberlain RC, Pelletier JH, Blanchard S, Hornik CP, Hill KD, Campbell MJ (2017) Evaluating appropriate use of pediatric echocardiograms for chest pain in outpatient clinics. J Am Soc Echocardiogr 30(7):708–713.  https://doi.org/10.1016/j.echo.2017.03.008 CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Albert Einstein College of MedicineBronxUSA
  2. 2.Division of CardiologyChildren’s Hospital at Montefiore / Albert Einstein College of MedicineBronxUSA
  3. 3.Division of CardiologyLucile Packard Children’s Hospital / Stanford University School of MedicinePalo AltoUSA
  4. 4.Children’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations