[II-AEPCYIA-5] Radiofrequency ablation vs cryoablation of right atrial lateral accessory pathway in pediatric age: acute and mid-term safety and efficacy profile
Keywords:right atrial lateral accessory pathway, transcatheter radiofrequency ablation, cryoablation
BACKGROUND AND AIM:In literature, transcatheter radiofrequency ablation (RFA) of right lateral accessory pathways (APs) in the pediatric population results in 92-95% of acute efficacy, with about 72% of long-term success rate. Conversely, cryoablation shows excellent acute success (97%), although with a 20% recurrence rate. This study sought to determine acute and long-term success rate, along with predictors of recurrences, in right lateral APs ablation carried out with RF versus cryoenergy approach.
METHOD:Datas from 53 consecutive pediatric patients who underwent RFA or cryoenergy ablation of right lateral APs between January 2020 and April 2022 at Bambino Gesù Children Hospital were analysed. APs were grouped into: right lateral (RL group), right antero-lateral (RAL group) and right postero-lateral (RPL group).
RESULTS:Out of 53 pts with at least 1 AP [57% males, mean age 12.16 ± 2.64 years, median weight 47 kg (IQR 36-59), height 155 cm (IQR 144 – 164 ), BSA 1.44mq (IQR 1.18-1.65)] all but one with Ebstein anomaly had structurally normal heart. Twenty-five (47.2%) belonged to the RL group, 14 (26.4%) to the RAL group, and remainders to the RPL group. Radiofrequency ablation was performed in 36 cases (68%), with a 86% acute success rate: 94.5% in the RL group, 100% in the RAL group, and 66.7% in the RPL group, respectively. Cryoablation was performed in 17 pts (32%) with a 82% acute success rate: 85.7% in the RL group, 87.5% in the RAL group, and 50% in the RPL group, respectively. Even including multiple redo procedures, over follow up (mean 28 ± 25 months) recurrences occured in 22% of RF cases (5 pts with RL APs, and 3 pts with RPL APs) vs 12% of cryoablations (2 pts with RPL APs). Median fluoroscopy time was 0.4 min (IQR 0.1-3.4) in RF vs 0.6 min (IQR 0.0 -3.1) in cryoenergy,
CONCLUSIONS:Transcatheter ablation of right atrial APs shows higher success rate for lateral and antero-lateral localizations. This study confirms that right lateral APs ablation is feasible safe and effective in the pediatric population, regardless of the type of energy and vascular access chosen.
METHOD:Datas from 53 consecutive pediatric patients who underwent RFA or cryoenergy ablation of right lateral APs between January 2020 and April 2022 at Bambino Gesù Children Hospital were analysed. APs were grouped into: right lateral (RL group), right antero-lateral (RAL group) and right postero-lateral (RPL group).
RESULTS:Out of 53 pts with at least 1 AP [57% males, mean age 12.16 ± 2.64 years, median weight 47 kg (IQR 36-59), height 155 cm (IQR 144 – 164 ), BSA 1.44mq (IQR 1.18-1.65)] all but one with Ebstein anomaly had structurally normal heart. Twenty-five (47.2%) belonged to the RL group, 14 (26.4%) to the RAL group, and remainders to the RPL group. Radiofrequency ablation was performed in 36 cases (68%), with a 86% acute success rate: 94.5% in the RL group, 100% in the RAL group, and 66.7% in the RPL group, respectively. Cryoablation was performed in 17 pts (32%) with a 82% acute success rate: 85.7% in the RL group, 87.5% in the RAL group, and 50% in the RPL group, respectively. Even including multiple redo procedures, over follow up (mean 28 ± 25 months) recurrences occured in 22% of RF cases (5 pts with RL APs, and 3 pts with RPL APs) vs 12% of cryoablations (2 pts with RPL APs). Median fluoroscopy time was 0.4 min (IQR 0.1-3.4) in RF vs 0.6 min (IQR 0.0 -3.1) in cryoenergy,
CONCLUSIONS:Transcatheter ablation of right atrial APs shows higher success rate for lateral and antero-lateral localizations. This study confirms that right lateral APs ablation is feasible safe and effective in the pediatric population, regardless of the type of energy and vascular access chosen.