Authors: Grace Wan Kevin M Shannon Jeremy P Moore
Publish Date: 2012/08/02
Volume: 35, Issue: 2, Pages: 235-242
Abstract
Exposure to ionizing radiation during electrophysiologic procedures in children is believed to increase the risk of future malignancy Electroanatomical navigation can reduce exposure but the cohort of children who derive the greatest benefit from this approach is incompletely defined We sought to determine factors associated with fluoroscopy exposure with conventional catheter ablation versus electroanatomical navigationA retrospective review of all ablation procedures over a 5year period during the transition to electroanatomical navigation performed by a single electrophysiologist was performed Fluoroscopy time 20 min was considered “prolonged” Statistical analysis was performed to determine differences among groupsTwo hundred thirtyfour subjects underwent catheter ablation during the study period conventional n = 127 navigation n = 107 Mean fluoroscopy decreased from 111 to 35 min with electroanatomical navigation p 00001 Overall 53/107 subjects 50 undergoing catheter ablation using electroanatomical navigation required no fluoroscopy of which atrioventricular nodal reentry tachycardia AVNRT n = 23 and rightsided accessory pathways n = 22 were most common p = 0001 Prolonged fluoroscopic exposure was observed for 22/127 17 subjects undergoing conventional fluoroscopy versus 3/107 3 subjects with electroanatomical navigation p = 0001 and was not observed after increased experience Flouroscopy time decreased significantly after the first 20 procedures p = 004 There was no difference in success complication or recurrence rate between groupsElectroanatomical navigation significantly reduced fluoroscopic exposure without compromising safety efficacy or recurrence Subjects with AVNRT and rightsided accessory pathways derived the greatest benefit as did those requiring prolonged fluoroscopy by the conventional approachThis study provides additional evidence on the importance of 3D mapping in clinical practice With the introduction of 3D mapping systems the investigators were able to reduce the fluoroscopy exposure during ablation procedures in pediatric patients
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