Significant reduction of fluoroscopy in pediatric catheter ablation procedures: long-term experience from a single...

Traditionally fluoroscopy has been used for navigation of catheters during electrophysiological procedures. Recent advances in electroanatomic mapping technologies resulted in a decrease and even in elimination of fluoroscopy exposure during these procedures.

Electrophysiological procedures were performed with the use EnSite NavX™ or Velocity™ (St. Jude Medical, St. Paul, MN, USA) systems. Following construction of the right atrial geometry, other relevant geometries were formed (right ventricle, coronary sinus, or left atrium). Fluoroscopy was used in patients with complex congenital heart disease, in younger children, and during transseptal punctures. Cryoablation or radiofrequency was used for catheter ablation.

A total of 305 patients underwent catheter ablation for various supraventricular and ventricular tachyarrhythmia substrates using EnSite system guidance. No fluoroscopy was used in 191 (63%) of these cases. The mean fluoroscopy time in the rest of the procedures was 13.9 ± 11.6 minutes (0.2-60 minutes). The mean procedure time was 184 ± 71 minutes. No complications were noted except for temporary diaphragmatic paralysis in one patient and temporary AV block in another patient following cryoablation. Acute success rate in achieving complete elimination of arrhythmia substrates was 95% (290/305). The recurrence rate was (31/271) 11.4% at a mean follow-up time of 42 ± 23 months.

Fluoroscopy can be significantly decreased or even eliminated in the majority of catheter ablation procedures. Long-term results demonstrate that this can be done efficiently and safely.