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The high-density grid catheter: A safe adjunctive tool in pediatric and complex congenital heart disease patients
Claire Newlon1, S Yukiko Asaki1, Thomas A Pilcher1
1Department of Pediatrics, Division of Pediatric Cardiology, Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA.
Insights
The Advisor™ High-Density Grid mapping catheter (HDGC) is safe for pediatric and congenital heart disease (CHD) patients. While procedure times were longer, complication rates were similar, suggesting HDGC is suitable for complex cases.
Area of Science:
- Cardiology
- Pediatric Electrophysiology
Background:
- The safety and effectiveness of the Advisor™ High-Density Grid mapping catheter (HDGC) in pediatric patients with congenital heart disease (CHD) require further investigation.
- Limited data exists on HDGC utilization in this specific population.
Purpose of the Study:
- To evaluate the safety and utility of HDGC in pediatric and CHD patients undergoing electrophysiology study and ablation.
- To determine the impact of HDGC use on complications, fluoroscopy time, procedure duration, acute ablation success, and arrhythmia recurrence.
Main Methods:
- A single-center retrospective cohort study was conducted.
- Included pediatric and CHD patients undergoing electrophysiology study and ablation.
- Compared outcomes between patients who had HDGC use and those who did not.
Main Results:
- HDGC was used in 28.3% of cases (74/261).
- HDGC patients were older, heavier, and had a higher prevalence of significant CHD, with different arrhythmia substrates.
- Complications were rare (1.9%) and not significantly different between groups. Procedure duration was longer with HDGC, but acute success was lower and recurrence higher, likely due to more complex cases.
Conclusions:
- HDGC use in pediatric and CHD patients is safe, with no increased complication rates.
- Lower acute success and higher recurrence rates in HDGC cases are likely attributable to the selection of more complex arrhythmia substrates.
Introduction:
The safety and utility of the Advisor™ High-Density Grid mapping catheter (HDGC) in children and congenital heart disease (CHD) patients are not well described.
Methods:
A single-center retrospective cohort study of pediatric and CHD patients undergoing electrophysiology study and ablation to determine the effect of HDGC use on outcomes including complications, fluoroscopy use, procedure duration, acute ablation success, and arrhythmia recurrence.
Results:
HDGC was used in 74/261 (28.3%) cases. HDGC subjects differed by median age (17 vs. 13 years; p < 0.001), weight (68 vs. 50 kg; p < 0.001), and prevalence of significant CHD (42% vs. 3%; p < 0.001). Arrhythmia substrates were dissimilar: HGDC cases had higher frequencies of intra-atrial re-entrant tachycardia (25.7% vs. 0.5%), atrial flutter (8.1% vs. 1.1%), ectopic atrial tachycardia (13.5% vs. 3.7%), and premature ventricular contractions (9.5% vs. 0.5%), and lower incidences of atrioventricular re-entrant tachycardia (16.2% vs. 46.1%). Complications were rare (n = 5, 1.9%) with no significant difference between groups (p = 1.00). Procedure duration-but not fluoroscopy exposure-was significantly longer in HDGC cases (median 256 vs. 216 min, p < 0.001). Acute success was lower (93.2% vs. 99.4%; p = 0.01) and recurrences higher (13.2% vs. 3.8%; p = 0.016) in HDGC compared to non-HDGC cases.
Conclusion:
HDGC use in children and CHD patients is safe and not associated with higher complication rates. The lower acute success and higher recurrence rates in HDGC cases likely reflect a bias toward HDGC use in more complex arrhythmia substrates rather than less favorable ablation outcomes.
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