Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience
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Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience Hasan Candaş Kafalı 1,2 Yakup Ergül 1
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Senem Özgür 1
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Gülhan Tunca Şahin 1
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Elif Özkilitçi Akay 3 & Alper Güzeltaş 1
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Received: 24 September 2019 / Accepted: 4 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background In children with typical atrioventricular nodal reentrant tachycardia (tAVNRT), cryoablation is preferred over radiofrequency ablation (RFA) because of its safety profile and acceptable long-term success rates. In this study, we have assessed the utility of 8-mm tip cryocatheters for tAVNRT ablation in our center. Methods All pediatric AVNRT patients who underwent cryoablation with an 8-mm tip cryocatheter in our center between 2013 and 2018 were included. EnSite™ (St. Jude Medical Inc., St. Paul, MN, USA) was used in all patients. Results A total of 120 patients (64 females, 53%) were included in this study, and the mean age was 13.9 years with a standard deviation of 2.5 years. Eleven patients (9.1%) had structural heart disease, and 12 patients (10%) had additional arrhythmia substrate. The mean number of effective cryolesions was 8 with a standard deviation of 2.3. Fluoroscopy was used in three patients (2.5%). There were minor complications in only four patients (3.3%)—transient first-degree atrioventricular block or transient incomplete right bundle branch block. Acute success rate of cryoablation was 108/120 (90%). In twelve patients, cryoablation was suboptimal, or it failed. The procedure was completed successfully with RFA in the same session in ten patients. Overall acute success rate of ablation (Cryo ± RFA) was 98.5%. During a mean follow-up period of 24.6 months with a standard deviation of 11.3 months, three patients had recurrence (2.5%). Time between the beginning of the effective cryolesion and termination of AVNRT was found associated with acute success of cryoablation (p = 0.013). Conclusions Cryoablation of AVNRT with an 8-mm tip catheter in children appears to be safe, with an acceptable acute success rate and a low recurrence rate. A faster termination of AVNRT during the cryolesion, slowing down before ending with atrioventricular block, is a good indicator for acute success Keywords Cryoablation . Pediatric . Typical atrioventricular nodal reentrant tachycardia (tAVNRT) . 8-mm tip catheter
1 Introduction Atrioventricular nodal reentrant tachycardia (AVNRT) is a common mechanism of supraventricular tachycardia (SVT) in
children especially with increasing age, making it the most common type of SVT in adolescents. Radiofrequency ablation (RFA) of AVNRT has a permanent complete atrioventricular (AV) block risk up to 2%, and it is also more commonly associated
* Hasan Candaş Kafalı [email protected]
Yakup Ergül [email protected] 1
Gülhan Tunca Şahin [email protected]
Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and
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