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CLINICAL RESEARCH: HEART RHYTHM DISORDERS

Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients

Efficacy, safety, and midterm follow-up

Department of Pediatric Cardiology, Bambino Gesù Hospital, Rome, Italy

Manuscript received September 22, 2004; revised manuscript received November 29, 2004, accepted December 2, 2004.

^_* Reprint requests and correspondence: Dr. Fabrizio Drago, Dipartimento Medico-Chirurgico di Cardiologia, Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio 4, 00165 Roma, Italia (Email: drago{at}opbg.net).

OBJECTIVES: We investigated the safety and efficacy of cryoablation in the treatment of pediatric patients with accessory pathways (APs) located near the atrioventricular junction and with atrioventricular nodal re-entrant tachycardia (AVNRT).

BACKGROUND: Few studies concern cryoablation in a significant number of pediatric patients involving treatment for supraventricular tachycardias (SVTs) with the reentry circuit located near the atrioventricular junction.

METHODS: Twenty-six pediatric patients (age range: 5 to 20 years) were treated; 14 had AVNRT, 10 had Wolff-Parkinson-White syndrome, and 2 had re-entrant SVT due to a concealed AP. Electrophysiologic study was performed with diagnostic catheters, and cryoablations were performed with a 7-F 4-mm-tip catheter (Freezor, CryoCath Technologies Inc., Kirkland, Canada). Cryomapping, used to identify the tissue site for safe arrhythmia ablation, was performed at –30°C for a maximum of 60 s. Cryoablations were from 4 to 8 min long at –75°C. Acute end points were noninducibility of AVNRT by programmed atrial stimulation at baseline or during isoproterenol performed 30 min after procedure, as well as noninducibility and conduction block over the AP. The chronic end point was arrhythmia recurrence after intervention.

RESULTS: No permanent cryo-related complications or adverse outcomes were reported. Twenty-four (92%) patients were acutely successful. During follow-up (range: 1 to 22 months), seven (29%) acutely successful pediatric patients experienced arrhythmia recurrence.

CONCLUSIONS: Acute results demonstrate cryoablation of SVTs with the reentry circuit located near the atrioventricular junction to be safe and efficacious in pediatric patients. However, the etiology of recurrences reported after intervention need further investigation.

Abbreviations and Acronyms   AP = accessory pathway   AV = atrioventricular   AVNRT = atrioventricular nodal re-entrant tachycardia   EPS = electrophysiologic study   RF = radiofrequency   SVT = supraventricular tachycardia   WPW = Wolff-Parkinson-White

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