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Exclusion of Fluoroscopy During Ablation Treatment of Right Accessory Pathway in Children
Author(s) -
DRAGO FABRIZIO,
SILVETTI MASSIMO STEFANO,
PINO ALFREDO,
GRUTTER GIORGIA,
BEVILACQUA MAURIZIO,
LEIBOVICH SHOSHANA
Publication year - 2002
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1046/j.1540-8167.2002.00778.x
Subject(s) - medicine , fluoroscopy , accessory pathway , ablation , orthodromic , catheter , catheter ablation , tachycardia , radiology , radiofrequency ablation , cardiology , surgery , electrophysiology
Electroanatomic Ablation of Accessory Pathways.Introduction: The field of pediatric electrophysiology poses many challenges to electrophysiologists. In particular there are two major concerns: (1) to reduce the amount of fluoroscopy exposure to patients and medical staff in the catheterization laboratory and (2) to minimize the number of vascular accesses. Prolonged fluoroscopy times are associated with radiofrequency (RF) ablation of right accessory pathways (APs), particularly the right free‐wall AP. The aim of this study was to eliminate the use of fluoroscopy during treatment of right‐sided APs in children while using a single‐catheter approach. Methods and Results: We studied 21 consecutive pediatric patients (mean age 11.3 ± 3.2 years ) with Wolff‐Parkinson‐White syndrome due to a right AP. To limit fluoroscopy use, we used a three‐dimensional navigation system that facilitated reconstruction of a three‐dimensional electroanatomic activation map along the tricuspid annulus either on the atrial side during orthodromic AV reciprocating tachycardia or along the ventricular side during anterograde preexcitation. RF application was successful and without complications in 20 patients (success rate 95%); moreover, 19 of the 21 patients underwent a single‐catheter procedure. The remaining two patients required an additional quadripolar catheter for atrial stimulation. A mean of 2 ± 1 RF applications were used during the whole study. Conclusion: Our study demonstrates that ablation of right APs in children can be performed without fluoroscopy using a single catheter with minimal amounts of RF applications. Our new technique is associated with high success rates.