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Use of three-dimensional mapping in young patients decreases radiation exposure even without a goal of zero fluoroscopy

Published online by Cambridge University Press:  28 October 2015

Cheyenne Beach ,
Lee Beerman ,
Sharon Mazzocco ,
Maria M. Brooks  and
Gaurav Arora
Cheyenne Beach*
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
Lee Beerman
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
Sharon Mazzocco
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
Maria M. Brooks
Affiliation:
Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, United States of America
Gaurav Arora
Affiliation:
Division of Pediatric Cardiology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, United States of America
*
Correspondence to: C. Beach, MD, Children’s Hospital of Pittsburgh of UPMC, One Children’s Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, United States of America. Tel: +412 692 8957; Fax: +412 692 5138; E-mail: [email protected]
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Abstract

At present, three-dimensional mapping is often used during cardiac ablations with an explicit goal of decreasing radiation exposure; three-dimensional mapping was introduced in our institution in 2007, but not specifically to decrease fluoroscopy time. We document fluoroscopy use and catheterisation times in this setting. Data were obtained retrospectively from patients who underwent ablation for atrioventricular nodal re-entrant tachycardia from January, 2004 to December, 2011. A total of 93 patients were included in the study. Among them, 18 patients who underwent radiofrequency ablation without three-dimensional mapping were included in Group 1, 13 patients who underwent cryoablation without three-dimensional mapping were included in Group 2, and 62 patients who underwent cryoablation with three-dimensional mapping were included in Group 3. Mean fluoroscopy times differed significantly (34.3, 23.4, and 20.3 minutes, p<0.001) when all the groups were compared. Group 3 had a shorter average fluoroscopy time that did not reach significance when compared directly with Group 2 (p=0.29). An unadjusted linear regression model showed a progressive decrease in fluoroscopy time (p=0.002). Mean total catheterisation times differed significantly (180, 211, and 210 minutes, p=0.02) and were related to increased ablation times inherent to cryoablation techniques. Acute success was achieved in 89, 100, and 97% of patients (p=0.25), and chronic success was achieved in 80, 92, and 93% of patients (p=0.38). Complication rates were similar (17, 23, and 7%, p=0.14). In conclusion, three-dimensional mapping systems decrease fluoroscopy times even without an explicit goal of zero fluoroscopy. Efficacy and safety of the procedure have not changed.

Keywords

Atrioventricular nodal re-entrant tachycardiaablationthree-dimensional mappingcryoablationradiofrequency
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 7 , October 2016 , pp. 1297 - 1302
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Copyright
© Cambridge University Press 2015 

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References

1. Ko, JK, Deal, B, Strasburger, J, Benson, DW Jr. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 1992; 69: 1028–1032.CrossRefGoogle ScholarPubMed
2. Ro, PS, Rhodes, LA. Atrioventricular node reentry tachycardia in pediatric patients. Prog Pediatr Cardiol 2001; 13: 3–10.CrossRefGoogle ScholarPubMed
3. Blaufox, AD, Warsy, I, D’Souza, M, Kanter, R. Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy. Pediatr Cardiol 2011; 32: 1110–1114.CrossRefGoogle ScholarPubMed
4. Food and Drug Administration. Public Health Advisory: avoidance of serious x-ray-induced skin injuries to patients during fluoroscopically-guided procedures. Rockville, MD; U.S. Food and Drug Administration, 1994. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PublicHealth Notifications/Ucm063084.htm. September 30, 1994. Updated April 30, 2009. Accessed September 17, 2011.Google Scholar
5. Food and Drug Administration. Important Information for Physicians and Other Health Care Professionals. Avoidance of Serious X-Ray-Induced Skin Injuries to Patients During Fluoroscopically-Guided Procedures. U.S. Food and Drug Administration, Rockville, MD, 1994. Retrieved September 17, 2011, from http://www.fda.gov/downloads/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/Medicalx-Rays/ucm116677.pdf.Google Scholar
6. Balter, S, Hopewell, J, Miller, D, Wagner, L, Zelefsky, M. Fluoroscopically guided interventional procedures: a review of radiation effects on patients’ skin and hair. Radiology 2010; 254: 326–341.CrossRefGoogle ScholarPubMed
7. Koenig, T, Wolff, D, Mettler, F, Wagner, L. Skin injuries from fluoroscopically guided procedure: part 1, characteristics of radiation injury. AJR 2001; 177: 3–11.CrossRefGoogle ScholarPubMed
8. Cummings, R, Mahle, W, Strieper, M, et al. Outcomes following electroanatomic mapping and ablation for the treatment of ectopic atrial tachycardia in the pediatric population. Pediatr Cardiol 2008; 29: 393–397.CrossRefGoogle ScholarPubMed
9. Tuzcu, V. A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system. PACE 2007; 30: 519–525.CrossRefGoogle ScholarPubMed
10. Smith, G, Clark, J. Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. PACE 2007; 30: 510–518.CrossRefGoogle Scholar
11. Clark, J, Bockoven, J, Lane, J, Patel, C, Smith, G. Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. PACE 2008; 31: 283–289.CrossRefGoogle ScholarPubMed
12. Papagiannis, J, Tsoutsinos, A, Kirvassilis, G, et al. Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventricular tachycardia in children. PACE 2006; 29: 971–978.CrossRefGoogle ScholarPubMed
13. Miyake, C, Mah, D, Atallah, J, et al. Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm 2011; 8: 519–525.CrossRefGoogle ScholarPubMed
14. LaPage, MJ, Saul, JP, Reed, JH. Long-term outcomes for cryoablation of pediatric patients with atrioventricular nodal reentrant tachycardia. Am J Cardiol 2010; 105: 1118–1121.CrossRefGoogle ScholarPubMed
15. Avari, J, Jay, K, Rhee, E. Experience and results during transition from radiofrequency ablation to cryoablation for treatment of pediatric atrioventricular nodal reentrant tachycardia. PACE 2008; 31: 454–460.CrossRefGoogle ScholarPubMed