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Electroanatomic mapping-guided pediatric catheter ablation with limited/zero fluoroscopy.

Serhat Koca1, Feyza Ayşenur Paç, Deniz Eriş

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Summary

Electroanatomic mapping systems enable nonfluoroscopic pediatric catheter ablation, significantly reducing radiation exposure. This approach demonstrates high success rates and low complication rates for treating pediatric arrhythmias.

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Area of Science:

  • Pediatric Cardiology
  • Electrophysiology
  • Medical Imaging

Background:

  • Fluoroscopy use in pediatric catheter ablation has declined due to advancements in mapping technologies.
  • Electroanatomic mapping systems offer a promising alternative for reducing radiation exposure in pediatric procedures.

Purpose of the Study:

  • To evaluate the efficiency and reliability of electroanatomic mapping systems for nonfluoroscopic pediatric catheter ablation.
  • To assess the safety and efficacy of eliminating fluoroscopy in pediatric arrhythmia ablation.

Main Methods:

  • Retrospective analysis of medical records for patients under 18 who underwent ablation between November 2016 and April 2018.
  • Nonfluoroscopic ablation was performed for right-sided arrhythmia foci; fluoroscopy was reserved for specific interventional steps like trans-septal puncture.

Main Results:

  • Catheter ablation was performed on 76 patients for 78 arrhythmia substrates using the EnSite Velocity system, with fluoroscopy used in only 18.4% of cases.
  • The mean fluoroscopy duration was 5.4±3.15 minutes when used. Acute success rate was 97.4%, with a low recurrence rate of 5.1%.
  • Complications were minimal, including one temporary right bundle branch block and one case of pericardial effusion post-cryoablation.

Conclusions:

  • Electroanatomic mapping systems facilitate the elimination of fluoroscopy in the majority of pediatric catheter ablation procedures.
  • This nonfluoroscopic approach achieves high acute success rates and maintains acceptable low complication rates, enhancing patient safety.