Use of visualizable and steerable sheath during catheter ablation in the pediatric and adult congenital heart disease population

Background The VIZIGO™ visualizable steerable sheath is widely used during electrophysiology procedures; however, data regarding its use in pediatric and adult congenital heart disease (ACHD) patients are limited. Objective To evaluate the safety and effectiveness of the VIZIGO™ visualizable steerable sheath in pediatric and ACHD patients undergoing electrophysiology procedures. Methods We retrospectively reviewed all electrophysiology procedures performed between September 2018 and December 2023 in which the VIZIGO™ sheath was used in pediatric patients (<21 years) and ACHD patients at a single tertiary referral center. Procedural characteristics, acute procedural success and major complications were analyzed. Results Sixty-two patients were included, comprising 44 pediatric and 18 ACHD patients. Left atrial access using the VIZIGO™ sheath was obtained in 14 procedures (22.6%) through transseptal or trans-baffle puncture. Acute procedural success was achieved in 93.2% of pediatric patients and 83.3% of ACHD patients. One major complication occurred (1.6%), consisting of a pericardial effusion requiring drainage following fluoroscopy-guided transseptal puncture in a pediatric patient. No vascular complications attributable to the sheath, thromboembolic or permanent atrioventricular block occurred. Conclusion This study represents, to our knowledge, the first evaluation of the VIZIGO™ visualizable steerable sheath in pediatric and ACHD patients. High acute procedural success and a low rate of major complications were observed across a broad spectrum of electrophysiology procedures in selected pediatric patients, predominantly larger children and adolescents, and in ACHD patients.