Midterm Results of Catheter Ablation in Children with Atrioventricular Nodal Reentry Tachycardia: High Success and Low Recurrence Rate with Limited/Zero Fluoroscopy

Background: Catheter ablation with radiofrequency or cryoenergy is the first choose for treatment of tachycardia in children and has been used safely via 3D electroanatomic mapping systems with lower radiation exposure. We aimed to evaluate retrospectively our results of catheter ablation guided by 3D electroanatomic mapping with zero/limited X-ray usage in children with atrioventricular nodal reentry tachycardia (AVNRT).

Method: All patients aged ≤18 years treated with AVNRT ablation between July 2016 and September 2021 were evaluated retrospectively.

Results: A total of 31 patients (mean age = 13.1 years [range: 5–17 years], male = 15 [48.3%]) with AVNRT treated with catheter ablation between July 2016 to September 2021. Two patients had congenital heart disease as atrial septal defect and shone complex separately. All patients had palpitation. One patient had additionally syncope and 1 patient had dizziness and dyspnea. Three patients were on β-blocker treatment and two on β-blocker plus flecainide. We performed radiofrequency ablation in 18 patients and cryoablation in 9. In five patients, we switched from radiofrequency ablation to cryoablation. The mean procedure time was 181.9 minutes (range: 60–330 minutes). Limited fluoroscopy was used only in eight patients, and the median fluoroscopy time was 0.9 minutes (range: 0.1–2.3 minutes) in these patients. The mean number of cryoablation application and duration were 7.28 (range: 6–10) and 34.9 minutes (range: 34–41). Three patients had also atrial tachycardia besides AVNRT and one patient atriofascicular pathway. The ablation area was the roof of coronary sinus in two patients. During the delivery of radiofrequency energy, junctional accelerated rhythm was seen in 21 patients, and 6 patients had a single echo beat and 6 patients had a single echo beat and AH-jump at the end of ablation procedure. Acute success rate was 100%. The midterm success rate was 100% at a median follow-up period of 26 months (range: 1–62 months). We have no recurrence up to date. No minor or major complication occurred on follow-up.

Conclusion: Catheter ablation by 3D electroanatomic-mapping technology can be performed effectively and safely with high success rate, low recurrence rate, and limited/null radiation exposure in the children with AVNRT.

Publication History

Article published online:
12 February 2022