Success Rates in Pediatric WPW Ablation Are Improved with 3-Dimensional Mapping Systems Compared with Fluoroscopy Alone: A Multicenter Study

• Published in: Journal of cardiovascular electrophysiology 2015-04, Vol.26 (4), p.412-416
• Main Authors: CERESNAK, SCOTT R., DUBIN, ANNE M., KIM, JEFFREY J., VALDES, SANTIAGO O., FISHBERGER, STEVEN B., SHETTY, IRA, ZIMMERMAN, FRANK, TANEL, RONN E., EPSTEIN, MICHAEL R., MOTONAGA, KARA S., CAPONE, CHRISTINE A., NAPPO, LYNN, GATES, GREGORY J., PASS, ROBERT H.
• Format: Article
• Language: English
• Subjects: 3-D mapping; ablation; Action Potentials; Adolescent; Age Factors; Cardiac arrhythmia; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; Chi-Square Distribution; Child; children; Electrocardiography; Electrophysiologic Techniques, Cardiac; Female; Fluoroscopy; Heart Conduction System - physiopathology; Heart Conduction System - surgery; Humans; Logistic Models; Male; Multivariate Analysis; Odds Ratio; pediatrics; Predictive Value of Tests; Radiation Dosage; Radiography, Interventional - methods; Recurrence; Retrospective Studies; Risk Factors; Success; Treatment Outcome; United States; Wolff-Parkinson-White Syndrome - diagnosis; Wolff-Parkinson-White Syndrome - physiopathology; Wolff-Parkinson-White Syndrome - surgery; WPW; Young Adult
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.12623

3‐D Mapping Improves Success Rates for WPW Ablation Introduction Three‐dimensional mapping (3‐D) systems are frequently used for ablation of supraventricular tachycardia. Prior studies have demonstrated radiation dosage reduction with 3‐D, but there are no data on whether 3‐D improves the efficacy of ablation of Wolff‐Parkinson‐White syndrome (WPW). We sought to determine if 3‐D improves the success rate for ablation of WPW in children. Methods Multicenter retrospective study including patients ≤21 years of age with WPW undergoing ablation from 2008 to 2012. Success rates using the 2 techniques (3‐D vs. fluoroscopy alone [FLUORO]) were compared. Results Six hundred and fifty‐one cases were included (58% male, mean age 13 ± 4 years, 366 [56%] 3‐D). Baseline characteristics including gender, weight, accessory pathway (AP) location, number of APs, and repeat ablation attempts were similar between the 2 groups (3‐D and FLUORO) The 3‐D group was slightly younger (12.7 ± 4.0 vs. 13.3 ± 4.0 years; P = 0.04) and less likely to undergo ablation utilizing cryoenergy (38 [10%] vs. 56 [20%]; P < 0.01). The 3‐D group had a higher acute success rate of ablation (355 [97%] vs. 260 [91%]; P < 0.01). No differences were seen in recurrence (16 [5%] vs. 26 [9%]; P = 0.09) or complication rates (1 [0.3%] vs. 1 [0.4%]; P = 0.86) between the groups. On multivariable analysis, 3‐D was shown to significantly improve success at ablation with an odds ratio of 3.1 (95% CI 1.44–6.72; P < 0.01). Conclusions Use of 3‐D significantly improved success rates for ablation of WPW in children. The increase in acute success associated with 3‐D suggests it is an important adjunct for catheter ablation of WPW in children.