Electroanatomic mapping-guided pediatric catheter ablation with limited/zero fluoroscopy

Abstract

Objective: The use of fluoroscopy in pediatric catheter ablation has decreased because of mapping systems. In this study, we present the efficiencyand reliability of the electroanatomic mapping system in nonfluoroscopic pediatric catheter ablation.Methods: The medical records of patients aged <18 years who underwent ablation between November 2016 and April 2018 were evaluated.Fluoroscopy was not used in cases involving ablation of right sided-arrhythmia foci. Fluoroscopy was used only for trans-septal puncture orretroaortic approach/coronary angiography.Results: A total of 76 patients underwent catheter ablation for 78 supraventricular and ventricular tachyarrhythmia substrates under the guidanceof EnSite Velocity system. Fluoroscopy was used in only 14 (18.4%) of these substrates. The mean fluoroscopy duration in these 14 procedureswas 5.4±3.15 min. No complications were noted, except a temporary right bundle branch block in one patient and pericardial effusionin another following cryoablation. The acute success rate in achieving complete elimination of arrhythmia substrates was 97.4% (76/78). Therecurrence rate was 5.1% (4/78) at follow-up.Conclusion: Fluoroscopy can be completely eliminated in most pediatric catheter ablation procedures with the use of mapping systems byachieving high acute success rates and acceptable low complication rates.