Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children

The field of pediatric electrophysiology poses many challenges to electrophysiologists. In particular there are two major concerns: (1) to reduce the amount of fluoroscopy exposure to patients and medical staff in the catheterization laboratory and (2) to minimize the number of vascular accesses. Prolonged fluoroscopy times are associated with radiofrequency (RF) ablation of right accessory pathways (APs), particularly the right free-wall AP. The aim of this study was to eliminate the use of fluoroscopy during treatment of right-sided APs in children while using a single-catheter approach.

We studied 21 consecutive pediatric patients (mean age 11.3 +/- 3.2 years) with Wolff-Parkinson-White syndrome due to a right AP. To limit fluoroscopy use, we used a three-dimensional navigation system that facilitated reconstruction of a three-dimensional electroanatomic activation map along the tricuspid annulus either on the atrial side during orthodromic AV reciprocating tachycardia or along the ventricular side during anterograde preexcitation. RF application was successful and without complications in 20 patients (success rate 95%); moreover, 19 of the 21 patients underwent a single-catheter procedure. The remaining two patients required an additional quadripolar catheter for atrial stimulation. A mean of 2 +/- 1 RF applications were used during the whole study.

Our study demonstrates that ablation of right APs in children can be performed without fluoroscopy using a single catheter with minimal amounts of RF applications. Our new technique is associated with high success rates.