Cryo-ablation for septal tachycardia substrates in pediatric patients
Mid-term results
Aya Miyazaki, MD,
Andrew D. Blaufox, MD*,
David L. Fairbrother, MD and
J. Philip Saul, MD
The Children's Heart Program of South Carolina-Medical University of South Carolina, Charleston, South Carolina
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Figure 1 Time of success after reaching –25°C. During atrioventricular reciprocating tachycardia ablation, accessory pathway (AP) block after reaching –25°C occurred in –3.3 ± 4.9 s in permanent success in comparison to 24.8 ± 25.5 s in transient success.
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Figure 2 Successful cryo-ablation (CA) with His potential in tachycardia of right anteroseptal (RAS) pathway (Patient #25). The large increase in noise from the ablation catheter is caused by the formation of the ice ball and cryo-adhesion. (A) Electrocardiogram at the initiation of cryo-mapping (CM) during tachycardia with the His potential seen in the ablation catheter. (B) Electrocardiogram at the termination of CA shows sinus rhythm and His potential is seen in ablation catheter. (C) Electrocardiogram shows the termination of tachycardia during CM. The supraventricular tachycardia was terminated with ventriculoatrial block just 0.6 s before reaching –25°C and 47.4 s from the initiation of CM. ABL = ablation; CS = coronary sinus.
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Figure 3 Successful cryo-ablation (CA) with His potential in ventricular tachycardia (Patient #31). (A) Electrocardiogram shows the initiation of cryo-mapping (CM). The His potential is clearly seen on the ablation catheter. (B) Fluoroscopic images in the antero-posterior view shows the position of the cryo-ablation catheter being very near the His bundle. The catheter is just under the aortic valve along the left ventricular septum via retrograde approach through the aortic valve. ABL = ablation; HBE = His bundle electrogram; HRA = high right atrium.
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