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A multicenter review of ablation in the aortic cusps in young people
Author(s) -
Nguyen Minh B.,
Ceresnak Scott R.,
Janson Christopher M.,
Fishberger Steven B.,
Love Barry A.,
Blaufox Andrew D.,
Motonaga Kara S.,
Dubin Anne M.,
Nappo Lynn,
Pass Robert H.
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13126
Subject(s) - medicine , ablation , cusp (singularity) , cardiology , radiofrequency ablation , tachycardia , ventricular tachycardia , intracardiac injection , demographics , geometry , mathematics , demography , sociology
Background Ablation within the aortic cusp is safe and effective in adults. There are little data on aortic cusp ablation in the pediatric literature. We investigated the safety and efficacy of aortic cusp ablation in young patients. Methods A retrospective, descriptive study of aortic cusp ablation in five pediatric electrophysiology centers from 2008 to 2014 was performed. All patients <21 years of age who underwent ablation in the aortic cusps were included. Factors analyzed included patient demographics, procedural details, outcomes, and complications. Results Thirteen patients met inclusion criteria (median age 16 years [range 10–20.5] and median body surface area 1.58 m 2 [range 1.12–2.33]). Substrates for ablation included: nine premature ventricular contractions or sustained ventricular tachycardia (69%), two concealed anteroseptal accessory pathways (APs) (15%), one Wolff‐Parkinson‐White with an anteroseptal AP (8%), and one ectopic atrial tachycardia (8%). Three‐dimensional electroanatomic mapping in combination with fluoroscopy was used in 12/13 (92%) patients. Standard 4‐mm‐tip radiofrequency (RF) current was used in 11/13 (85%) and low‐power irrigated‐tip RF in 2/13 (15%). Angiography was used in 13/13 and intracardiac echocardiography was additionally utilized in 3/13 (23%). Ablation locations included: eight noncoronary (62%), three left (23%), and two right (15%) cusps. Ablation was acutely successful in all patients. At median follow‐up of 20 months, there was one recurrence of PVCs (8%). There were no ablation‐related complications and no valvular injuries observed. Conclusion Arrhythmias originating from the coronary cusps in this series were successfully and safely ablated in young people without injury to the coronary arteries or the aortic valve.