Key result
Most pediatric coronary arteries sit within 3 mm of coronary sinus and appendage ablation sites.
Why the study?
Coronary artery injury risk increases when an artery is within 3 mm of an ablation site, but coronary imaging prior to pediatric catheter ablation is not commonly performed.
What is the proximity of coronary arteries to potential ablation sites in pediatric patients?
Observational (n=67)
No
What is the proximity of coronary arteries to potential ablation sites in pediatric patients?
Most pediatric patients have coronary arteries within 3 mm of potential ablation sites in the coronary sinus and appendage bases, highlighting the importance of pre-procedural imaging to prevent coronary injury during catheter ablation.
Warrants caution during ablation near appendage base; leaves open prospective validation of imaging strategies.
BACKGROUND: Coronary artery (CA) injury from catheter ablation is an uncommon complication, but the risk is under-recognized. The risk for CA injury significantly increases when a CA is within 3 mm of the site of ablation, but CA imaging to assess for CA proximity to ablation sites is not commonly performed in children prior to ablation. OBJECTIVE: The aim of the study was to assess CA proximity to potential ablation sites. METHODS: A retrospective review of all coronary computed tomography angiograms (CTAs) in pediatric patients <18 years of age at Mayo Clinic from 2017 through 2023 was conducted. The proximity of CAs to potential ablation sites in the coronary sinus and the appendage bases were measured. RESULTS: Seventy-two CTAs in 67 patients >15 kg and <18 years old were included. Median age was 12 years, and median weight was 41 kg. In right dominant CA circulation, 23/36 (64%) had a CA within 3 mm of the coronary sinus. In left and co-dominant CA circulation, 26/26 (100%) had a CA within 3 mm of the coronary sinus. The right CA was within 3 mm of the appendage base in 49/69 (71%). The circumflex CA was within 3 mm of the appendage base in 50/68 (74%). CONCLUSION: Most pediatric patients have a CA ≤ 3 mm from potential ablation sites in the coronary sinus and base of the appendages. Precautions should be taken to avoid CA damage before performing catheter ablation in these areas.
No takes yet. Share an insight, caveat, or question.
Magnan et al. (2026) conducted an observational in Pediatric patients evaluated for potential catheter ablation (n=67). Coronary computed tomography angiography was evaluated on Proximity of coronary arteries to potential ablation sites in the coronary sinus and the appendage bases. Coronary arteries were located within 3 mm of potential ablation sites in the coronary sinus in 64-100% of pediatric patients, and near the appendage bases in 71-74% of cases.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: