Thorac Cardiovasc Surg 2014; 62 - p46
DOI: 10.1055/s-0034-1394069

Radiofrequency ablation of right-sided accessory pathways in children: how have 3 D systems and cool-tip catheters changed success and recurrence rates?

M. Telishevska 1, A. Buiatti 1, V. Semmler 1, S. Ammar 1, T. Reents 1, P. Ewert 1, I. Deisenhofer 1, M. Horndasch 1, P. Schön 1, G. Hessling 1
  • 1German Heart Center Munich

Aim: The aim of this study was to show our experience with radiofrequency ablation (RFA) of right-sided accessory pathways (APs) in children over the last 10 years with a special focus on the introduction of 3D mapping systems and cool-tip catheters.

Methods: Between May 2004 and January 2014, a total of 110 ablations of right-sided APs were performed at our institution in 100 children with a median age of 13.6 ± 3.1 years (range 4.0 - 17.9 years). Until 2010, 59 ablations were performed using conventional fluoroscopy and a non-irrigated catheter (NIC) in all 59 cases. Since 2010, 51 ablations were performed using a 3D navigation system (Carto3 n=5, Ensite NavX N=46) together with a cool-tip catheter (CTC) in all 51 cases. A 3D activation map of the right atrium and along the tricuspid annulus was performed either during sinus rhythm or during ventricular stimulation/orthodromic reciprocating tachycardia.

Results: Overall, acute procedural success rate was 94%. AP recurrence was observed in 14% of cases. It was the highest (25%) for right lateral APs. Acute success rates were equivalent with 55/59 (93.2%) cases in the conventional group (CG) and 48/51 (94.1%) cases in the 3D navigation system group (3D). 3D mapping significantly reduced total fluoroscopy time (26.1±30.2 min versus (vs) 15.0±13.6 min for 3D, P <0.001). There were no significant differences in total procedure time between the two mapping approaches (160.8±73.7 min (CG) vs. 143.5±54.9 min (3D), P >0.05). When analyzed by NIC and CTC, there were significant reductions in AP recurrences (P <0.001) using a CTC (11% vs 4%). We observed complete AV block in 1 patient with a right anteroseptal AP (CG).

Conclusions: The results of this study confirm the efficacy and safety of RFA of right sided AP. In combination with a 3D navigation system and CTC a significant reduction of fluoroscopy time and recurrence rate can be achieved.