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Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience

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Abstract

Background

In children with typical atrioventricular nodal reentrant tachycardia (tAVNRT), cryoablation is preferred over radiofrequency ablation (RFA) because of its safety profile and acceptable long-term success rates. In this study, we have assessed the utility of 8-mm tip cryocatheters for tAVNRT ablation in our center.

Methods

All pediatric AVNRT patients who underwent cryoablation with an 8-mm tip cryocatheter in our center between 2013 and 2018 were included. EnSite™ (St. Jude Medical Inc., St. Paul, MN, USA) was used in all patients.

Results

A total of 120 patients (64 females, 53%) were included in this study, and the mean age was 13.9 years with a standard deviation of 2.5 years. Eleven patients (9.1%) had structural heart disease, and 12 patients (10%) had additional arrhythmia substrate. The mean number of effective cryolesions was 8 with a standard deviation of 2.3. Fluoroscopy was used in three patients (2.5%). There were minor complications in only four patients (3.3%)—transient first-degree atrioventricular block or transient incomplete right bundle branch block. Acute success rate of cryoablation was 108/120 (90%). In twelve patients, cryoablation was suboptimal, or it failed. The procedure was completed successfully with RFA in the same session in ten patients. Overall acute success rate of ablation (Cryo ± RFA) was 98.5%. During a mean follow-up period of 24.6 months with a standard deviation of 11.3 months, three patients had recurrence (2.5%). Time between the beginning of the effective cryolesion and termination of AVNRT was found associated with acute success of cryoablation (p = 0.013).

Conclusions

Cryoablation of AVNRT with an 8-mm tip catheter in children appears to be safe, with an acceptable acute success rate and a low recurrence rate. A faster termination of AVNRT during the cryolesion, slowing down before ending with atrioventricular block, is a good indicator for acute success

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Authors and Affiliations

  1. Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey

    Hasan Candaş Kafalı, Senem Özgür, Gülhan Tunca Şahin, Alper Güzeltaş & Yakup Ergül

  2. Istanbul Sağlık Bilimleri Universitesi Mehmet Akif Ersoy Eğitim Araştırma Hastanesi, Istasyon Mahallesi İstanbul Caddesi Bezirganbahçe Mevki, 34303, Küçükçekmece/İstanbul, Turkey

    Hasan Candaş Kafalı

  3. Department of Anesthesiology and Reanimation, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey

    Elif Özkilitçi Akay

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  1. Hasan Candaş Kafalı
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  2. Senem Özgür
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  3. Gülhan Tunca Şahin
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Correspondence to Hasan Candaş Kafalı.

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Ethical approval was obtained from the Local Ethics Committee for this retrospective study.

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Informed consent was obtained from all the patients included in this study.

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Kafalı, H.C., Özgür, S., Şahin, G.T. et al. Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience. J Interv Card Electrophysiol 62, 113–122 (2021). https://doi.org/10.1007/s10840-020-00868-x

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