• J Formos Med Assoc · Oct 2022

    Zero-fluoroscopy ablation of left-sided arrhythmia substrates in children - Mid-term safety and feasibility study from transaortic approach.

    • Wei-Chieh Tseng, Mei-Hwan Wu, Chun-Wei Lu, Kun-Lang Wu, Jou-Kou Wang, Ming-Tai Lin, Chun-An Chen, Cheng-Wei Chen, and Shuenn-Nan Chiu.
    • Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital/National Taiwan University Children's Hospital, Taiwan.
    • J Formos Med Assoc. 2022 Oct 1; 121 (10): 2035-2043.

    BackgroundA widely used method of treating left-sided arrhythmia substrates in children is retrograde transaortic ablation under fluoroscopic guidance. However, the feasibility, safety, and efficacy of this approach under zero fluoroscopy (ZF) guidance, especially the mid-term safety of anatomy and function of aortic valves, have yet to be proven.MethodsAll consecutive patients who received ablation of left-sided arrhythmias between January 2012 and June 2020 and below 20 years-old were enrolled. The study group submitted to 55 ZF-guided procedures using cardiac mapping system (EnSite Precision), whereas 49 procedures were performed under fluoroscopic guidance in the control group. Echocardiographic studies took place before and 6-months after ablative procedures.ResultsOne-hundred-and-two patients (male, 66; female, 36) underwent a total of 104 ablative procedures. Mean procedural durations were 83.9 ± 44.4 min in the study group and 64.8 ± 29.1 min in the control group, respectively (p = .01; the 95% confidence interval, -33.57 to -4.63). Corresponding fluoroscopic times were .5 ± 2.2 min and 24.7 ± 13.9 min (p < .001; the 95% confidence interval, 20.15 to 28.22). ZF may be reasonably applied after a learning curve of 20 cases. Immediate procedural success and recurrence rates were similar in each groups. There was no detectable progression of aortic regurgitation in any of the patients during serial follow-up of echocardiography.ConclusionZF-guided retrograde transaortic ablation of left-sided arrhythmia substrates proved safe in children at midterm follow-up, reducing radiation exposure significantly within a learning curve of <20 cases.Copyright © 2022 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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