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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Cryo-ablation for septal tachycardia substrates in pediatric patients

Mid-term results

The Children's Heart Program of South Carolina-Medical University of South Carolina, Charleston, South Carolina

Manuscript received August 30, 2004; revised manuscript received October 12, 2004, accepted October 26, 2004.

^* Reprint requests and correspondence: Dr. Andrew D. Blaufox, Children's Heart Program of South Carolina-MUSC, 165 Ashley Avenue, PO Box 250915, Charleston, South Carolina 29425 (Email: Blaufoad{at}musc.edu).

OBJECTIVES: The aim of this study was to evaluate the efficacy and safety of catheter-based cryo-therapy for septal tachycardia substrates in pediatric patients.

BACKGROUND: Cryo-therapy may be particularly useful for ablation of septal tachycardias, including atrioventricular nodal re-entry tachycardia (AVNRT), atrioventricular reciprocating tachycardia (AVRT), and ventricular tachycardia (VT) originating high in the conduction system.

METHODS: Thirty-one pediatric patients (median = 13.7 years, range 5.3 to 19.6 years) with septal tachycardia substrates underwent cryo-ablation (CA). Twenty-two had AVNRT, 8 AVRT, and 1 VT. Applications were considered cryo-maps (CMs) if the temperature set-point was –35°C or the application time was <120 s. Other lesions were considered CAs.

RESULTS: A total of 242 CMs (4 per patient, range 0 to 40 CMs) and 89 CAs (2 per patient, range 1 to 8 CMs) were performed, for a total cryo-therapy time of 689 s/patient (range 158 to 3,300 s). Procedural success with cryo-therapy was achieved in 27 of 31 patients (87.1%), including two procedures with a His potential at the CA location and three performed in tachycardia. The success rate for AVNRT was higher than for AVRT (95.5% vs. 62.5%, p < 0.05). For AVRT, a sustained effect on accessory pathway conduction occurred –3.3 ± 4.9 s after reaching –25°C, whereas for those sites at which the effect was transient, the effect took 24.8 ± 25.5 s (p = 0.07). Transient atrioventricular (AV) block occurred during eight cryo-applications (1 CA, 7 CMs) with immediate return of normal AV conduction upon cessation of application. There were no other complications.

CONCLUSIONS: Cryo-therapy was used to effectively and safely ablate septal tachycardias in this group of 31 pediatric patients. Cryo-therapy may be more effective for AVNRT than septal AVRT.

Abbreviations and Acronyms   AV = atrioventricular   AVNRT = atrioventricular nodal re-entry tachycardia   AVRT = atrioventricular reciprocating tachycardia   CA = cryo-ablation   CM = cryo-map   RAS = right anteroseptal   RFA = radiofrequency ablation   VT = ventricular tachycardia

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