Impact of Irrigated Contact-Force Sensing on Fluoroscopy Exposure and Efficiency in Pediatric AVNRT Ablation

Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common forms of supraventricular tachycardia in children and adolescents. Radiofrequency (RF) catheter ablation is an established and effective treatment; however, the close anatomical relationship between the slow pathway and the compact atrioventricular (AV) node poses a risk of conduction system injury. Irrigated contact-force (CF) sensing catheters provide real-time feedback on catheter-tissue interaction and may enhance lesion delivery and procedural efficiency. Despite increasing use in adult populations, data regarding their use in pediatric AVNRT remain limited. To evaluate the safety, efficacy, and procedural characteristics of CF-guided RF ablation versus conventional non-contact-force (non-CF) catheters in pediatric patients undergoing slow-pathway modification for AVNRT. This retrospective study included consecutive pediatric patients (< 18 years) who underwent AVNRT ablation between January 2021 and December 2024. Patients were treated using either an irrigated CF-sensing catheter (n = 130) or a non-CF catheter (n = 48). Continuous variables were analyzed according to their distribution, and appropriate statistical tests were applied. Time-to-recurrence was assessed using Kaplan-Meier survival analysis with log-rank testing. The CF group demonstrated significantly shorter procedure time (median 58 vs. 90 min; p < 0.001), less frequent fluoroscopy use (1.5% vs. 14.6%; p = 0.002), and shorter RF duration (73 vs. 89.5 s; p = 0.024) compared with the non-CF group. Acute procedural success was achieved in all patients in the CF group and in 89.6% of patients in the non-CF group (p = 0.001). No major complications were observed in either group. Recurrence rates were numerically higher in the CF group (6.1% vs. 2.1%; p = 0.448). Kaplan-Meier analysis demonstrated a statistically significant difference in recurrence-free survival (log-rank p = 0.015); however, this finding should be interpreted cautiously due to differences in follow-up duration and the limited number of events. Irrigated CF-guided RF ablation appears to be a safe and effective option for the treatment of pediatric AVNRT. CF-guided ablation was associated with improved procedural efficiency and high acute success. Differences in recurrence patterns should be interpreted cautiously in light of potential confounding factors, including follow-up duration and temporal learning effects.