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Comparison of cryoablation with 3D mapping versus conventional mapping for the treatment of atrioventricular re-entrant tachycardia and right-sided paraseptal accessory pathways

Published online by Cambridge University Press:  14 September 2015

Mario S. Russo ,
Fabrizio Drago ,
Massimo S. Silvetti ,
Daniela Righi ,
Corrado Di Mambro ,
Silvia Placidi ,
Monica Prosperi ,
Michele Ciani ,
Maria T. Naso Onofrio  and
Vittorio Cannatà
Mario S. Russo
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Fabrizio Drago*
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Massimo S. Silvetti
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Daniela Righi
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Corrado Di Mambro
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Silvia Placidi
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Monica Prosperi
Affiliation:
Paediatric Cardiac Arrhythmias Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Palidoro-Fiumicino, Rome, Italy
Michele Ciani
Affiliation:
St. Jude Medical, Agrate Brianza, Rome, Italy
Maria T. Naso Onofrio
Affiliation:
Freelancer, Rome, Italy
Vittorio Cannatà
Affiliation:
Enterprise Risk Management, Bambino Gesù Children’s Hospital and Research Institute, Rome, Italy
*
Correspondence to: F. Drago, MD, Pediatric Cardiac Arrhythmia Complex Unit and Syncope Unit, Bambino Gesù Children’s Hospital and Research Institute, Via Torre di Palidoro snc, 00050 Palidoro-Fiumicino, Rome, Italy. Tel: +39 0668593559; Fax: +39 0668593375; E-mail: fabrizio.drago@opbg.net
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Abstract

Aim

Transcatheter cryoablation is a well-established technique for the treatment of atrioventricular nodal re-entry tachycardia and atrioventricular re-entry tachycardia in children. Fluoroscopy or three-dimensional mapping systems can be used to perform the ablation procedure. The aim of this study was to compare the success rate of cryoablation procedures for the treatment of right septal accessory pathways and atrioventricular nodal re-entry circuits in children using conventional or three-dimensional mapping and to evaluate whether three-dimensional mapping was associated with reduced patient radiation dose compared with traditional mapping.

Methods

In 2013, 81 children underwent transcatheter cryoablation at our institution, using conventional mapping in 41 children – 32 atrioventricular nodal re-entry tachycardia and nine atrioventricular re-entry tachycardia – and three-dimensional mapping in 40 children – 24 atrioventricular nodal re-entry tachycardia and 16 atrioventricular re-entry tachycardia.

Results

Using conventional mapping, the overall success rate was 78.1 and 66.7% in patients with atrioventricular nodal re-entry tachycardia or atrioventricular re-entry tachycardia, respectively. Using three-dimensional mapping, the overall success rate was 91.6 and 75%, respectively (p=ns). The use of three-dimensional mapping was associated with a reduction in cumulative air kerma and cumulative air kerma–area product of 76.4 and 67.3%, respectively (p<0.05).

Conclusions

The use of three-dimensional mapping compared with the conventional fluoroscopy-guided method for cryoablation of right septal accessory pathways and atrioventricular nodal re-entry circuits in children was associated with a significant reduction in patient radiation dose without an increase in success rate.

Keywords

Supraventricular tachycardiathree-dimensional mappingcryoablationchildren
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 5 , June 2016 , pp. 931 - 940
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Copyright
© Cambridge University Press 2015 

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