Cryoablation Versus Radiofrequency Ablation in the Management of Pediatric Supraventricular Tachyarrhythmia: A...

Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients, often requiring catheter ablation for effective treatment. Two primary techniques, radiofrequency ablation (RFA) and cryoablation (CA), are widely used; however, their comparative safety and efficacy remain subjects of debate, with no clear consensus on the preferred approach. This systematic review and meta-analysis aimed to evaluate and compare the efficacy and safety of RFA and CA in pediatric patients with SVT, focusing on the primary outcomes of acute success and recurrence rates. The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies included comparative analyses such as randomized controlled trials, non-randomized trials, and observational studies that specifically evaluated RFA and CA in pediatric populations with SVT. Exclusion criteria included studies involving adult populations, those without comparative groups, case reports, case series, and conference abstracts. Data extracted from the included studies encompassed acute success rates, recurrence rates, and complication rates, providing a comprehensive overview of the performance and safety profiles of RFA and CA in this patient group. Acute success rates were high for both techniques (RFA: 96.3%, CA: 94.9%; p = 0.137). However, RFA demonstrated a significantly lower recurrence rate (7.9% vs. 14.4%; odds ratio (OR): 0.408, 95% CI: 0.242-0.689, p < 0.001). CA was associated with longer procedure durations (mean difference: 9.684 minutes, p = 0.437) and significantly reduced fluoroscopy times (mean difference: 6.566 minutes, p = 0.032). Complication rates were comparable, with a non-significant trend favoring RFA (OR: 0.363, p = 0.112). Overall, both RFA and CA were found to be effective and safe for pediatric SVT. RFA offers durable results with lower recurrence rates, while CA minimizes fluoroscopy time, thereby reducing radiation exposure. Treatment selection should be individualized, considering factors such as the type and location of the arrhythmia as well as specific procedural risks.