3D Non-Fluoroscopic Cryoablation of Right-Sided Accessory Pathways in Children: Monocentric Study and Literature Review |
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Authors: | Fabrizio Drago Irma Battipaglia Pietro Paolo Tamborrino Luigina Porco Camilla Calvieri Mario Salvatore Russo Vincenzo Pazzano Romolo Remoli Massimo Stefano Silvetti |
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Institution: | Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy |
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Abstract: | Background: Cryoablation of accessory pathways (APs) is effective and very safe in children, as previously
reported by our group. The aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children, comparing results obtained with the Ensite VelocityTM and the
more recent Ensite PrecisionTM 3D mapping systems. Methods and Results: From January 2016 to December
2019, 102 pediatric patients mean age 12.5 ± 2.8, 62 males (61% of total cohort)] with right APs underwent
3D non-fluoroscopic transcatheter cryoablation at our Institution. Fifteen (14.7%) patients had previously undergone catheter ablation. Acute procedural success rate was 95.1% (n = 97). No significant differences were detected
in acute success rates achieved with Ensite VelocityTM or Ensite PrecisionTM systems nor between manifest (94%)
and concealed APs (100%). No permanent complications occurred. During follow-up (428 ± 286 days, median
396 days interquartile range 179-713]), 19 patients (19.6%) had recurrences. Recurrences were more frequent
for parahissian/anterior APs compared to midseptal/posterior and lateral APs (p = 0.043). Recurrences were
not related to the Ensite system used. A redo ablation procedure was attempted in 13 cases, 11 cryoablation
and 2 radiofrequency ablations: the former was successful in 10 cases out of 11 (90.9%). Conclusion: 3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,
resulting in great benefit to the children. Recurrence rates are not high and patients can be retreated with
cryo-energy with higher success rates. |
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Keywords: | 3D Mapping accessory pathway children cryoablation pediatric tachyarrhythmias |
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