Key result
Non-fluoroscopic 3D-guided ablation matches fluoroscopy for acute success in pediatric AVNRT.
Why the study?
Non-fluoroscopic RFA guided by three-dimensional mapping offers enhanced precision, but its safety and effectiveness compared with fluoroscopic RFA in pediatric AVNRT needed evaluation.
Does non-fluoroscopic radiofrequency ablation guided by 3D mapping improve procedural characteristics and safety compared to fluoroscopic radiofrequency ablation in pediatric patients with AVNRT?
Cohort (n=119)
Yes
Does non-fluoroscopic radiofrequency ablation guided by 3D mapping improve procedural characteristics and safety compared to fluoroscopic radiofrequency ablation in pediatric patients with AVNRT?
Absolute Event Rate: 100% vs 98.2%
p-value: p=0.479
Non-fluoroscopic radiofrequency ablation guided by 3D mapping is a safe and effective alternative to fluoroscopic ablation for pediatric AVNRT, achieving similar acute success and recurrence rates without radiation exposure.
Supports non-fluoroscopic 3D mapping as a viable radiation-free option in pediatric AVNRT; leaves open randomized confirmation of safety and outcomes.
Background Non-fluoroscopic cryoablation is considered safe for pediatric atrioventricular nodal reentrant tachycardia (AVNRT), but concerns about prolonged procedures and recurrence persist, requiring continued use of radiofrequency ablation (RFA). Non-fluoroscopic RFA, guided by three-dimensional mapping, offers enhanced precision. This study compares its safety and effectiveness with fluoroscopic RFA in pediatric AVNRT. Methods We retrospectively analyzed children undergoing RFA without (X− group) or with (X+ group) fluoroscopy at multiple centers (2011–2024). Patients who received fluoroscopic and three-dimensional mapping guidance were excluded. Baseline characteristics, electrophysiological data, and ablation outcomes were compared. Results Among 119 patients (X+, 57; X−, 62), there was a significantly higher rate of successful ablation sites in the lower Koch triangle on 3D electroanatomical mapping (3D-EAM). However, the procedure time, acute success rate, recurrence-free survival of AVNRT, and injury to the conduction system were similar between the groups. No permanent complete atrioventricular block was observed in either group. The longer procedure time was independently correlated with ablation location outside of the low Koch triangle, lower common pathway block, and slow pathway modification. Dual AV nodes without inducible tachycardia had lower AVNRT-free survival than typical and atypical AVNRT (80% vs. 96.5% vs. 100%, p = 0.025). Younger children can achieve successful ablation with fewer ablation pulses and a smaller ablation catheter profile, with similar recurrence and conduction system injury. Conclusions Non-fluoroscopic RFA, guided by 3D-EAM, achieves comparable acute and mid-term outcomes to fluoroscopic RFA in pediatric AVNRT. The successful site of slow pathway ablation was significantly lower when using 3D-EAM compared with fluoroscopy.
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Chuang et al. (2025) conducted a cohort in Pediatric atrioventricular nodal reentrant tachycardia (AVNRT) (n=119). Non-fluoroscopic radiofrequency ablation guided by 3D electroanatomical mapping vs. Fluoroscopic radiofrequency ablation was evaluated on Acute success rate (p=0.479). Non-fluoroscopic radiofrequency ablation guided by 3D electroanatomical mapping achieved a 100% acute success rate, comparable to the 98.2% success rate of fluoroscopic ablation in pediatric AVNRT.
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