Advertisement

Catheter ablation for supraventricular tachycardia in children ≤ 20 kg using an electroanatomical system

  • Serhat Koca
  • Celal Akdeniz
  • Volkan Tuzcu
Article
  • 18 Downloads

Abstract

Purpose

Catheter ablation is the only choice of treatment in some small children with medically refractory supraventricular tachycardia (SVT). Electroanatomical mapping systems (EMS) are more commonly utilized in electrophysiological procedures in recent years, which resulted in a significant decrease in fluoroscopy exposure. The potential benefit of EMS in small children has not been studied. Therefore, we investigated the outcomes of children undergoing catheter ablation weighing ≤ 20 kg using an electroanatomical mapping system.

Methods

This study evaluated the outcomes, characteristics, and follow-ups of children ≤ 20 kg who underwent SVT ablations between April 2012 and April 2018 in a pediatric electrophysiology center where EMS were routinely used.

Results

In a 6-year period, 1129 children underwent SVT catheter ablation under EMS guidance at our institution. A total of 84 of them were weighing ≤ 20 kg. The acute success rate was 97.6% in 85 tachycardia substrates. No fluoroscopy was used in 58 of the patients, while a median of 5 (4–14) min of fluoroscopy was used in the remaining 26 patients. Recurrences were seen in 4 patients (4.8%) at a mean follow-up of 3.89 ± 2.08 years. Five patients developed non-vital complications (2 right bundle block and 3 temporary complete block that spontaneously resolved during the procedure).

Conclusions

The outcome of catheter ablation with the guidance of EMS for the treatment of SVT in small children is favorable. Fluoroscopy exposure can be decreased and even eliminated in most patients.

Keywords

Small children Catheter ablation Electroanatomical mapping systems Supraventricular tachycardia Fluoroscopy exposure 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants 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.

Informed consent

Informed consent was obtained from the children’s parents/guardians.

Research involving with human and animal participants

This article does not contain any studies with animals performed by any of the authors.

References

  1. 1.
    Kugler JD, Danford DA, Houston KA, Felix G. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol. 2002;13:336–41.CrossRefGoogle Scholar
  2. 2.
    Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol. 2004;15:759–70.CrossRefGoogle Scholar
  3. 3.
    Aiyagari R, Saarel EV, Etheridge SP, Bradley DJ, Dick M 2nd, Fischbach PS. Radiofrequency ablation for supraventricular tachycardia in children < or =15 kg is safe and effective. Pediatr Cardiol. 2005;26:622–6.CrossRefGoogle Scholar
  4. 4.
    Chiu SN, Lu CW, Chang CW, Chang CC, Lin MT, Lin JL, et al. Radiofrequency catheter ablation of supraventricular tachycardia in infants and toddlers. Circ J. 2009;73:1717–21.CrossRefGoogle Scholar
  5. 5.
    Akdeniz C, Ergul Y, Kiplapinar N, Tuzcu V. Catheter ablation of drug resistant supraventricular tachycardia in neonates and infants. Cardiol J. 2013;20:241–6.CrossRefGoogle Scholar
  6. 6.
    Gerber TC, Carr JJ, Arai AE, Dixon RL, Ferrari VA, Gomes AS, et al. Ionizing radiation in cardiac imaging: a science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation. 2009;119:1056–65.CrossRefGoogle Scholar
  7. 7.
    Miyake CY, Mah DY, Atallah J, Oikle HP, Melgar ML, Alexander ME, et al. Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm. 2011;8:519–25.CrossRefGoogle Scholar
  8. 8.
    Ozyilmaz I, Ergul Y, Akdeniz C, Ozturk E, Tanidir IC, Tuzcu V. Catheter ablation of idiopathic ventricular tachycardia in children using the EnSite NavX system with/without fluoroscopy. Cardiol Young. 2014;24:886–92.CrossRefGoogle Scholar
  9. 9.
    Smith G, Clark JM. Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing Clin Electrophysiol. 2007;30:510–8.CrossRefGoogle Scholar
  10. 10.
    Tuzcu V. Significant reduction of fluoroscopy in pediatric catheter ablation procedures: long-term experience from a single center. Pacing Clin Electrophysiol. 2012;35:1067–73.CrossRefGoogle Scholar
  11. 11.
    Drago F, Silvetti MS, Di Pino A, Grutter G, Bevilacqua M, Leibovich S. Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. J Cardiovasc Electrophysiol. 2002;13:778–82.CrossRefGoogle Scholar
  12. 12.
    Asakai H, Kirsh JA. Optimizing outcomes of catheter ablation in infants and toddlers. Expert Rev Cardiovasc Ther. 2015;13:333–40.CrossRefGoogle Scholar
  13. 13.
    Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013;15:1337–82.CrossRefGoogle Scholar
  14. 14.
    Blaufox AD, Paul T, Saul JP. Radiofrequency catheter ablation in small children: relationship of complications to application dose. Pacing Clin Electrophysiol. 2004;27:224–9.CrossRefGoogle Scholar
  15. 15.
    Kantoch MJ, Gulamhusein SS, Sanatani S. Short- and long-term outcomes in children undergoing radiofrequency catheter ablation before their second birthday. Can J Cardiol. 2011;27:523.e3–9.CrossRefGoogle Scholar
  16. 16.
    Kugler JD, Danford DA, Deal BJ, Gillette PC, Perry JC, Silka MJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. N Engl J Med. 1994;330:1481–7.CrossRefGoogle Scholar
  17. 17.
    De Ponti R, Zardini M, Storti C, Longobardi M, Salerno-Uriarte JA. Trans-septal catheterization for radiofrequency catheter ablation of cardiac arrhythmias. Eur Heart J. 1998;19:943–50.CrossRefGoogle Scholar
  18. 18.
    De Ponti R, Cappato R, Curnis A, Della Bella P, Padeletti L, Raviele A, et al. Trans-septal catheterization in the electrophysiology laboratory: data from a multicenter survey spanning 12 years. J Am Coll Cardiol. 2006;47:1037–42.CrossRefGoogle Scholar
  19. 19.
    Yoshida S, Suzuki T, Yoshida Y, Watanabe S, Nakamura K, Sasaki T, et al. Feasibility and safety of transseptal puncture procedures for radiofrequency catheter ablation in small children weighing below 30 kg: single-centre experience. Europace. 2016;18:1581–6.CrossRefGoogle Scholar
  20. 20.
    Ehrlinspiel DM, Gass M, Balmer C. Transseptal puncture for radiofrequency catheter ablations of left-sided arrhythmias in a paediatric population. Cardiol Young. 2017;27:267–72.CrossRefGoogle Scholar
  21. 21.
    Bashore TM, Bates ER, Berger PB, Clark DA, Cusma JT, Dehmer GJ, et al. Task Force on Clinical Expert Consensus Documents. American College of Cardiology/Society for Cardiac Angiography and Interventions Clinical Expert Consensus Document on cardiac catheterization laboratory standards. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2011;37:2170–214.CrossRefGoogle Scholar
  22. 22.
    Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, et al. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council’s Biological Effects of Ionizing Radiation VII Report. Am Heart J. 2009;157:118–24.CrossRefGoogle Scholar
  23. 23.
    Efstathopoulos EP, Katritsis DG, Kottou S, Kalivas N, Tzanalaridou E, Giazitzoglou E, et al. Patient and staff radiation dosimetry during cardiac electrophysiology studies and catheter ablation procedures: a comprehensive analysis. Europace. 2006;8:443–8.CrossRefGoogle Scholar
  24. 24.
    See J, Amora JL, Lee S, Lim P, Teo WS, Tan BY, et al. Non-fluoroscopic navigation systems for radiofrequency catheter ablation for supraventricular tachycardia reduce ionising radiation exposure. Singap Med J. 2016;57:390–5.CrossRefGoogle Scholar
  25. 25.
    Backhoff D, Klehs S, Müller MJ, Schneider H, Kriebel T, Paul T, et al. Radiofrequency catheter ablation of accessory atrioventricular pathways in infants and toddlers ≤ 15 kg. Pediatr Cardiol. 2016;37:892–8.CrossRefGoogle Scholar
  26. 26.
    An HS, Choi EY, Kwon BS, Kim GB, Bae EJ, Noh CI, et al. Radiofrequency catheter ablation for supraventricular tachycardia: a comparison study of children aged 0-4 and 5-9 years. Pacing Clin Electrophysiol. 2013;36:1488–94.CrossRefGoogle Scholar
  27. 27.
    De Ponti R. Cryothermal energy ablation of cardiac arrhythmias 2005: state of the art. Indian Pacing Electrophysiol J. 2005;1:12–24.Google Scholar
  28. 28.
    Papagiannis J, Papadopoulou K, Rammos S, Katritsis D. Cryoablation versus radiofrequency ablation for atrioventricular nodal reentrant tachycardia in children: long-term results. Hell J Cardiol. 2010;51:122–6.Google Scholar
  29. 29.
    Avari JN, Jay KS, Rhee EK. Experience and results during transition from radiofrequency ablation to cryoablation for treatment of pediatric atrioventricula nodal reentrant tachycardia. Pacing Clin Electrophysiol. 2008;31:454–60.CrossRefGoogle Scholar
  30. 30.
    Insulander P, Bastani H, Braunschweig F, Drca N, Kennebäck G, Schwieler J, et al. Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients-confirmed safety but very late recurrences occur. Europace. 2017;19:1038–42.PubMedGoogle Scholar
  31. 31.
    Andrade JG, Khairy P, Dubuc M. Catheter cryoablation: biology and clinical uses. Circ Arrhythm Electrophysiol. 2013;6:218–27.CrossRefGoogle Scholar
  32. 32.
    Saul JP, Hulse JE, Papagiannis J, Van Praagh R, Walsh EP. Late enlargement of radiofrequency lesions in infant lambs: implications for ablation procedures in small children. Circulation. 1994;90:492–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric and Genetic Arrhythmia Center, Pediatric CardiologyIstanbul Medipol UniversityIstanbulTurkey
  2. 2.Pediatric CardiologyYuksek Ihtisas HospitalAnkaraTurkey

Personalised recommendations