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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?
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.