Abstract 11453: Beyond Anatomy: Use of Sinus Propagation Mapping to Identify the Slow Pathway for Cryoablation in Pediatric Patients

Abstract

Introduction: Slow pathway (SP) modification via cryoablation is a common treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in pediatric patients. Traditionally, SP modification was achieved by anatomical landmarks, ideal electrogram characteristics, or low voltage bridge mapping. Recently, sinus propagation mapping (SPM) is a tool that has been used to augment identification of the SP. We hypothesize that the use of SPM will decrease the total number of ablations performed and decrease the number of ablations until the SP was successfully modified without a significant increase in procedure time. Methods: We conducted a retrospective review of patients who underwent cryoablation for AVNRT from August 2016 through March 2021. There were no other technological or procedural changes during the study period besides the addition of SPM. We excluded patients greater than 21 years of age, the use of radiofrequency ablation, prior AVNRT ablation, additional pathways or arrhythmias, and those with congenital heart disease. Patients were divided into two groups: those who did and did not undergo SPM. Mann-Whitney U tests were utilized to compare significance between the two groups. Results: Out of 122 patients identified by IMPACT database query, 103 met inclusion criteria. Fifty-two patients (50.5%) had SPM completed during their procedures. Age, weight, and BSA were not statistically different between the groups. Ablation was acutely successful in all but two patients, both in the non-SPM group. The median number of ablations needed until successful SP modification was 2 in patients who underwent SPM, and 4 in the non-SPM group (p = 0.03). There was no significant difference between total number of ablations between groups. The median total procedural time was longer in the SPM group (152 vs 125 min, p = 0.01). There was no difference in clinical recurrence or complications between the two groups. Conclusions: Sinus propagation mapping can be utilized to further improve the successful treatment of AVNRT with cryotherapy by lowering the number of ablations needed until successful SP modification. However, the technique requires some additional time to collect sufficient data points to create the sinus map.