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Fluoroless catheter ablation of accessory pathways in adult and pediatric patients: a single centre experience

Mehmet Yazici1, Nikola Lakič1, Tine Prolič Kalinšek1

  • 1Cardiovascular Surgery Department, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.

The International Journal of Cardiovascular Imaging
|February 2, 2021
PubMed

Insights

Radio-frequency ablation (RFA) and cryo-ablation (CRA) are safe, effective treatments for accessory pathway (AP) tachycardias without fluoroscopy. Radio-frequency ablation showed better long-term outcomes than cryo-ablation, especially for septal accessory pathways.

Area of Science:

  • Electrophysiology
  • Cardiology
  • Medical Imaging

Background:

  • Catheter ablation (CA) using radio-frequency ablation (RFA) and cryo-ablation (CRA) effectively treats accessory pathway (AP) mediated tachycardias in adults and children.
  • Non-fluoroscopic techniques in CA reduce radiation exposure, enhancing patient safety.
  • The efficacy and safety of completely fluoroless RFA and CRA for APs remain to be fully elucidated.

Purpose of the Study:

  • To evaluate the efficacy and safety of completely fluoroless catheter ablation (CA) procedures using radio-frequency ablation (RFA) and cryo-ablation (CRA) in pediatric and adult patients with accessory pathways (APs).
  • To compare the outcomes of RFA and CRA in the context of fluoroless procedures for AP-mediated tachycardias.

Main Methods:

  • Retrospective analysis of consecutive patients with AP-related tachycardia or high-risk asymptomatic ventricular pre-excitation.
  • Utilized three-dimensional electro-anatomical mapping (EAM) and intra-cardiac echocardiography (ICE) as primary imaging modalities, completely avoiding fluoroscopy.
  • Included 116 patients (68 pediatric, 48 adult) undergoing either RFA (96 patients) or CRA (20 patients) for various AP locations.

Main Results:

  • Both RFA and CRA demonstrated high acute success rates (97.9% and 95%, respectively) without procedure-related complications.
  • Radio-frequency ablation showed significantly lower recurrence rates (8.33%) compared to cryo-ablation (40%), particularly for septal APs (9.1% vs. 38.9%).
  • Pediatric patients exhibited similar procedural parameters and outcomes to adult patients.

Conclusions:

  • Completely fluoroless RFA and CRA are safe and effective treatment options for adult and pediatric patients with AP-related tachycardias.
  • Radio-frequency ablation offers superior long-term outcomes compared to cryo-ablation, with a lower recurrence rate, especially in cases involving septal accessory pathways.
  • The findings support the adoption of fluoroless ablation techniques, particularly RFA, for managing AP-mediated tachycardias.

Keywords:
Accessory pathwaysCatheter ablationElectro-anatomic mapping systemFluorolessIntra-cardiac echocardiography

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