Key result
Pediatric AVNRT ablation using 3D mapping achieves ~99% acute success with minimal fluoroscopy.
Why the study?
Multiple 3D mapping strategies and ablation techniques have evolved to improve outcomes and reduce complications for AVNRT, motivating an updated comprehensive review of contemporary management in children.
In children and CHD patients with AVNRT, transcatheter ablation guided by 3D mapping systems offers near-perfect acute success rates and low recurrence with minimal fluoroscopy.
Answers are grounded in this paper and cite their sources.
Supports 3D mapping for pediatric AVNRT ablation with minimal radiation; leaves open need for randomized trials to confirm outcomes.
Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia in children and congenital heart disease (CHD) patients. Nowadays, in large enough children, chronic treatment for symptomatic and recurrent AVNRT episodes relies on transcatheter ablation. Indeed, many three-dimensional (3D) mapping strategies and ablation techniques have been developed and it helped to increase success rates and to reduce complications. Therefore, this study aimed to perform an updated comprehensive review of the available literature regarding contemporary management of AVNRT in children. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. We found that in recent times many investigations have demonstrated that 3D mapping systems allow to localize more precisely the ablation substrate, with minimal use of fluoroscopy. The most frequently employed mapping strategies are the low-voltage bridge strategy together with the search for the SP potential and the Sinus Rhythm Propagation Map with the identification of areas of Wave Collision or Pivot Points. For transcatheter ablation in pediatric settings, radiofrequency (RF) ablation was first used in the 1990s, while cryoablation was introduced in 2003 and nowadays represents the most used energy for AVNRT ablation in this population. Indeed, its specific features, such as reversible cryomapping, cryoadhesion and the precision in lesion delivery, made this technique very appealing to decrease complications and fluoroscopy time. As regards AVNRT in CHD patients, it represents the third most common form of arrhythmia in children with CHD. However, in this subgroup ablation remains challenging and experience limited, since anatomy may be atypical and the areas of ablation less predictable or less accessible.
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Drago et al. (2024) conducted a review in Atrioventricular nodal reentrant tachycardia (AVNRT). Transcatheter ablation with 3D mapping was evaluated. Transcatheter ablation of atrioventricular nodal reentry tachycardia in children using 3D mapping systems achieved a 99.2% acute success rate and a 3.3% recurrence rate with minimal fluoroscopy.
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