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Safety of Ablation Within the Coronary Venous Sinus in Pediatric Patients
Shankar Baskar1, Martin J LaPage2, Nicholas J Ollberding3
1The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Catheter ablation in the coronary sinus is safe for pediatric patients, with rare coronary artery injury. Operators should monitor for transient heart block during ablation procedures.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Catheter ablation in the coronary sinus (CS) carries a risk of inadvertent coronary artery (CA) injury.
- Limited data exists on the safety of CS ablation in pediatric populations.
Purpose of the Study:
- To evaluate the safety of catheter-based ablation within the CS in pediatric patients.
- To describe ablation energy source utilization patterns in pediatric CS ablations.
Main Methods:
- Multi-center, retrospective study (1999-2019) involving seven centers.
- Included pediatric patients (≤21 years) undergoing CS ablation.
- Data on ablation techniques, energy sources, and complications were analyzed.
Main Results:
- 211 pediatric patients included; accessory pathways were the primary target.
- Cryoablation (55%), non-irrigated RF (40%), and irrigated RF (6%) were used.
- One case of transient CA spasm and six cases of transient high-grade AV block occurred; no permanent complications.
Conclusions:
- Coronary arteriography before ablation is infrequent, but acute CA injury is rare.
- Transient heart block is a notable complication requiring vigilant monitoring of AV nodal conduction.
Background:
Catheter-based ablation in the coronary venous sinus (CS) can be associated with inadvertent coronary artery (CA) injury. However, a significant gap remains in the literature with regard to safety of such ablation in pediatrics.
Objectives:
The primary aim of this study was to describe the safety of catheter-based ablation within the CS. Secondary aim was to describe the practice pattern of ablation energy source within the CS among pediatric centers.
Methods:
This was a multi-center, retrospective study over a period of 20 years (1999-2019) involving seven centers. Pediatric patients (≤ 21 years of age) undergoing ablation within the CS were included.
Results:
A total of 211 patients were included (median age: 14 [IQR: 10.5, 16.0]). Accessory pathways were the target in almost 90% of the patients with cryoablation in 55%, nonirrigated RF in 40% and irrigated RF in 6%. Only 16% had coronary arteriogram done before RF. There was a single patient who had CA injury, in the form of a transient spasm of the left circumflex CA following RF in the proximal CS. There was transient high-grade AV block in six patients (2.8%) who either had RF or cryoablation. There was no permanent AV block.
Conclusion:
The use coronary arteriogram before RF in the CS is infrequent, although acute CA injury appears to be rare following such ablation. Transient heart block is not uncommon, and the operators need to be vigilant in monitoring AV nodal conduction.
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