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Pediatric Cardiology

, Volume 38, Issue 7, pp 1426–1433 | Cite as

Utility of Echocardiography in Detecting Silent Complications After Pediatric Catheter Ablations

  • Shahnawaz M. Amdani
  • Salaam Sallaam
  • Peter P. Karpawich
  • Sanjeev Aggarwal
Original Article

Abstract

Although transcatheter arrhythmia ablation (TCA) has been performed in children for over two decades, guidelines for routine use of post-ablation transthoracic echocardiography (TTE) are absent. We sought to determine the efficacy of TTE after apparently uneventful TCA procedures in detecting adverse findings and identify predisposing factors. A retrospective review of clinical and procedural data on patients who underwent TCA for supraventricular arrhythmias from 2000 to 2015 was performed. Pre- and post-ablation TTE data were reviewed. All patients were followed at 1 week, 6 and 12 months post-TCA. A repeat TTE was performed at 12 months on patients in whom post-TCA abnormalities were found. Patients were divided into two groups: those with and without adverse TTE findings and comparative analysis between variables was performed. Data on 252 patients, 52% males, mean age 14 ± 3 years were analyzed. New onset or worsening atrioventricular valve regurgitation occurred in 17 (6.7%), a small pericardial effusion in 3 (1.2%) and worsened ventricular function in 2 patients (0.8%). Patients in the complication group had higher mean number of ablations (22.6 ± 15.3 vs. 16.8 ± 9.2, p 0.001) and required longer duration of ablation (sec) (254.6 ± 256.4 vs. 180.9 ± 158.9, p < 0.001). TCA location (including coronary sinus), energy source, arrhythmia substrate, and a trans-septal approach were noncontributory to any adverse findings. Routine post-ablation TTE uncovers asymptomatic self-resolving abnormalities that typically do not require any intervention.

Keywords

Echocardiogram Supraventricular tachycardia (SVT) Atrioventricular reentrant tachycardia (AVRT) Atrioventricular nodal reentrant tachycardia (AVNRT) Radiofrequency ablation Cryoablation Pericardial effusion Valvular regurgitation Ventricular function 

Notes

Author Contributions

Dr. Shahnawaz Amdani and Dr. Sanjeev Aggarwal conceptualized and designed the study, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Salaam Sallaam carried out the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr. Peter Karpawich drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.

Funding

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

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to disclose.

References

  1. 1.
    Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS et al (2004) Prospective assessment after pediatric cardiac ablation. J Cardiovasc Electrophysiol 15(7):759–770CrossRefPubMedGoogle Scholar
  2. 2.
    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. N Engl J Med 330(21):1481–1487CrossRefPubMedGoogle Scholar
  3. 3.
    Nielsen JC, Kottkamp H, Piorkowski C, Gerds-Li JH, Tanner H, Hindricks G (2006) Radiofrequency ablation in children and adolescents: results in 154 consecutive patients. Europace 8(5):323–329CrossRefPubMedGoogle Scholar
  4. 4.
    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(04):386–388CrossRefPubMedGoogle Scholar
  5. 5.
    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):461–467CrossRefPubMedGoogle Scholar
  6. 6.
    Schaffer MS, Gow RM, Moak JP, Saul JP (2000) Participating members of the pediatric electrophysiology society. mortality following radiofrequency catheter ablation (from the pediatric radiofrequency ablation registry). Am J Cardiol 86(6):639–643CrossRefPubMedGoogle Scholar
  7. 7.
    Blaufox AD, Felix GL, Saul JP (2001) Radiofrequency catheter ablation in infants ≤ 18 months old when is it done and how do they fare?: short-term data from the pediatric ablation registry. Circulation 104(23):2803–2808CrossRefPubMedGoogle Scholar
  8. 8.
    Co-Chairs TF (2016) PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 13(6):e252Google Scholar
  9. 9.
    Van Hare GF, Colan SD, Javitz H, Carmelli D, Knilans T, Schaffer M, Kugler J, Byrum CJ, Saul JP (2007) participating members of the pediatric electrophysiology society. prospective assessment after pediatric cardiac ablation: fate of intracardiac structure and function, as assessed by serial echocardiography. Am Heart J 153(5):815–820CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ceresnak SR, Dubin AM, Kim JJ, Valdes SO, Fishberger SB, Shetty I et al (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):412–416CrossRefPubMedGoogle Scholar
  11. 11.
    Haissaguerre M, Gaita F, Fischer B, Egloff P, Lemetayer P, Warin JF (1992) Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus. Circulation 86(5):1464–1468CrossRefPubMedGoogle Scholar
  12. 12.
    Langberg JJ, Man KC, Vorperian VR, Williamson B, Kalbfleisch SJ, Strickberger SA, Hummel JD, Morady F (1993) Recognition and catheter ablation of subepicardial accessory pathways. J Am Coll Cardiol 22(4):1100–1104CrossRefPubMedGoogle Scholar
  13. 13.
    Giorgberidze I, Saksena S, Krol RB, Mathew P (1995) Efficacy and safely of radiofrequency catheter ablation of left-sided accessory pathways through the coronary sinus. Am J Cardiol 76(5):359–365CrossRefPubMedGoogle Scholar
  14. 14.
    Karpawich PP (2007) Catheter-delivered cryoablation in the pediatric coronary sinus: assessing newer arrhythmia therapies. J Cardiovasc Electrophysiol 18(6):598–600CrossRefPubMedGoogle Scholar
  15. 15.
    Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B et al (2013) American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 26(9):965–1012CrossRefPubMedGoogle Scholar
  16. 16.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802CrossRefPubMedGoogle Scholar
  17. 17.
    Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J et al (2005) Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circulation 111(9):1100–1105CrossRefPubMedGoogle Scholar
  18. 18.
    Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J et al (2009) Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol 53(19):1798–1803CrossRefPubMedGoogle Scholar
  19. 19.
    Minich LL, Snider AR, Dick M (1992) Doppler detection of valvular regurgitation after radiofrequency ablation of accessory connections. Am J Cardiol 70(1):116–117CrossRefPubMedGoogle Scholar
  20. 20.
    Frias PA, Taylor MB, Kavanaugh-McHugh A, Fish FA (1999) Low incidence of significant valvar insufficiency following retrograde aortic radiofrequency catheter ablation in young patients. J Interv Cardiac Electrophysiol 3(2):181–185CrossRefGoogle Scholar
  21. 21.
    Walsh EP (2007) Interventional electrophysiology in patients with congenital heart disease. Circulation 115(25):3224–3234CrossRefPubMedGoogle Scholar
  22. 22.
    Buddhe S, Singh H, Du W, Karpawich PP (2012) Radiofrequency and cryoablation therapies for supraventricular arrhythmias in the young: five - year review of efficacies. Pacing Clin Electrophysiol 35(6):711–717CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Shahnawaz M. Amdani
    • 1
  • Salaam Sallaam
    • 1
  • Peter P. Karpawich
    • 1
  • Sanjeev Aggarwal
    • 1
  1. 1.Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children’s Hospital of MichiganWayne State University School of MedicineDetroitUSA

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