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EXPRESS PUBLICATIONS

Transcatheter cryoablation of tachyarrhythmias in children

Initial experience from an international registry

Joel A. Kirsh, MD, FRCP(C), FACC^*,*, Gil J. Gross, MD, FRCP(C), FACC^*, Stephen O'Connor, PhD, Robert M. Hamilton, MD, FRCP(C)^* Cryocath International Patient Registry

^* Division of Cardiology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Cryocath Technologies Inc., Kirkland, Quebec, Canada

Manuscript received June 21, 2004; revised manuscript received October 14, 2004, accepted October 18, 2004.

^* Reprint requests and correspondence: Dr. Joel A. Kirsh, Division of Cardiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada (Email: joel.kirsh{at}sickkids.ca).

OBJECTIVES: We sought to describe the early pediatric experience of transcatheter cryoablation, and identify whether specific arrhythmia substrates and/or ablation locations were particularly suited to cryoablation.

BACKGROUND: Radiofrequency (RF) ablation has become established therapy for pediatric tachyarrhythmias. However, challenges remain in terms of the safety and efficacy of RF ablation in specific locations; new methods may address these issues.

METHODS: Prospective data were available for 64 patients age 13 ± 4 (mean ± SD) years undergoing cryoablation at 14 centers participating in the Cryocath International Patient Registry. Dysrhythmia duration was 5.0 ± 4.2 years, with diagnoses of atrioventricular node re-entrant tachycardia (AVNRT) (n = 30), anteroseptal (n = 11), midseptal (n = 5), or other (n = 15) accessory pathway (AP) mediated AV re-entry, ventricular tachycardia (VT) (n = 3), and ectopic atrial tachycardia (EAT) (n = 2). Two patients had more than one arrhythmia substrate. Transcatheter cryoablation was offered by cardiologist preference after written informed procedural consent of each patient and/or legal guardian. Cryomapping was performed at –30°C and cryoablation was delivered with 4-min applications at –75°C.

RESULTS: Acute success was achieved in 45 of 65 (69%) cryoablation patients, with best success rates in AVNRT (83%) and right septal AP (75%), and lower success rates in other AP (43%), VT (66%), and EAT (0%). No device-related adverse events were reported. The success of radiofrequency (RF) ablation applied in 14 cryoablation failures was 4 of 4 for AVNRT patients, 1 of 1 for anteroseptal AP patients, 5 of 6 for other AP patients, 0 of 1 for VT patients, and 0 of 2 for EAT patients.

CONCLUSIONS: Transcatheter cryoablation is a safe and well-tolerated alternative to RF ablation in pediatric patients on the basis of our initial experience. Success is highest in AVNRT and in substrates recognized as technically challenging or risky for RF ablation.

Abbreviations and Acronyms   AP = accessory pathway   AV = atrioventricular   AVNRT = atrioventricular nodal re-entrant tachycardia   AVRT = atrioventricular re-entrant tachycardia   EAT = ectopic atrial tachycardia   EP = electrophysiologic   RF = radiofrequency   VT = ventricular tachycardia

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