Key result
3D non-fluoroscopic transcatheter cryoablation of right-sided accessory pathways in children achieved a 95.1% acute procedural success rate with no permanent complications.
Why the study?
To evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right-sided accessory pathways in children, comparing the Ensite VelocityTM and Ensite PrecisionTM 3D mapping systems.
Does 3D non-fluoroscopic cryoablation using different 3D mapping systems achieve high acute success rates in pediatric patients with right-sided accessory pathways?
Cohort (n=102)
No
Does 3D non-fluoroscopic cryoablation using different 3D mapping systems achieve high acute success rates in pediatric patients with right-sided accessory pathways?
3D non-fluoroscopic cryoablation of right-sided accessory pathways in children is highly effective and safe, with comparable acute success rates between Ensite Velocity and Precision mapping systems.
May support Precision over Velocity for pediatric right AP cryoablation; leaves open randomized confirmation of clinical benefit.
Background: Cryoablation of accessory pathways (APs) is effective and very safe in children, as previously reported by our group. The aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children, comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping systems. Methods and Results: From January 2016 to December 2019, 102 pediatric patients [mean age 12.5 ± 2.8, 62 males (61% of total cohort)] with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our Institution. Fifteen (14.7%) patients had previously undergone catheter ablation. Acute procedural success rate was 95.1% (n = 97). No significant differences were detected in acute success rates achieved with Ensite VelocityTM or Ensite PrecisionTM systems nor between manifest (94%) and concealed APs (100%). No permanent complications occurred. During follow-up (428 ± 286 days, median 396 days [interquartile range 179-713]), 19 patients (19.6%) had recurrences. Recurrences were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs (p = 0.043). Recurrences were not related to the Ensite system used. A redo ablation procedure was attempted in 13 cases, 11 cryoablation and 2 radiofrequency ablations: the former was successful in 10 cases out of 11 (90.9%). Conclusion: 3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy, resulting in great benefit to the children. Recurrence rates are not high and patients can be retreated with cryo-energy with higher success rates.
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Drago et al. (2021) conducted a cohort in Right-sided accessory pathways (APs) (n=102). 3D non-fluoroscopic transcatheter cryoablation was evaluated on Acute procedural success rate. 3D non-fluoroscopic transcatheter cryoablation of right-sided accessory pathways in children achieved a 95.1% acute procedural success rate with no permanent complications.
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