Abstract 12177: Lead Foot: Correlates to Increased Use of Fluoroscopy During Catheter Ablation in the Pediatric and Congenital Heart Electrophysiology Lab
Purpose: Electroanatomic mapping technologies have reduced fluoroscopy (fluoro) use in pediatric catheter ablation (ABL). Despite application of these modalities, some procedures continue to require substantial use of fluoro. We aimed to identify factors that undermine efforts to minimize radiation exposure in a diverse group of pediatric and congenital heart patients.
Methods: All ABL procedures over 3 years at a single pediatric heart center in which non-fluoro navigation was employed were reviewed. Procedures using 10 minutes or more of fluoro (high fluoro group; HF) were compared to those using less than 10 minutes (low fluoro group; LF). Group comparison of patient and procedural characteristics was made in the entire cohort as well as separate congenital heart and anatomically normal heart subsets.
Results: During the study period 416 ABLs were performed on 383 patients, in which a total of 471 substrates were addressed. In patients with anatomically normal hearts (n=311; 81%), 332 ABLs were completed. Median fluoro for all patients was 6.7 min; 5.1 min for ABL in anatomically normal hearts. LF comprised 61% of all ABL and 69% of anatomically normal hearts. HF procedures were associated with congenital heart disease (76% vs. 24%; p≤.0001). Considering only anatomically normal hearts, HF was associated with any accessory pathway (64% vs. 47%; p=0.01), posteroseptal substrates (22% vs. 9%; p=0.002), and ventricular substrates (12% vs. 1%; p≤.0001). All cases of intra-atrial re-entrant tachycardia were HF. Trans-septal puncture was associated with HF (47% vs. 23%; p≤.0001) though this association was not observed when controlling for AVNRT ABL. The use of RF rather than cryoablation was associated with HF (58% vs. 39%; p≤.0001). There was no difference in recurrence or complication rates between the fluoro groups.
Conclusions: Catheter ablation in patients with congenital heart disease and using of RF (compared with cryo) is more commonly associated with HF. Among procedures involving an accessory pathway, trans-septal puncture was not associated with HF. Additional efforts need to be applied to these situations in order to achieve the radiation reductions seen in other procedures.
- Pediatric electrophysiology
- Arrhythmia mapping
- Pediatric cardiology
- Adult congenital heart disease
- © 2013 by American Heart Association, Inc.