Abstract 15893: Rf vs Cryo: Effect of Ablation Energy Source on Outcomes of Pediatric AVNRT Ablation - Insight From the NCDR® Impact Registry

Abstract

Introduction: AV nodal reentrant tachycardia (AVNRT) is a common form of SVT in pediatrics. Ablation can be curative; however, the choice between radiofrequency ablation (RF) and cryoablation (Cryo) remains controversial due to a lack of contemporary large comparison studies in the pediatric population. Methods: AVNRT ablation outcomes were retrospectively analyzed utilizing the NCDR ® IMPACT Registry from 4/1/16 to 3/31/19. Data from subjects aged 1-21 years undergoing elective first-time slow pathway (SP) modification for AVNRT were included. Exclusion criteria were age<1-year, structural heart disease, >1 targeted arrhythmia mechanism, and >1 ablation catheter/energy source. The primary outcome was acute ablation success, defined as elimination of SP conduction or SP conduction with ≤ 1 AV nodal echo without SVT. Secondary outcomes included major adverse effects (MAE) of AV block, temporary or permanent pacing, death, cardiac arrest, tamponade, or embolic stroke. Results: Among 2235 patients (mean age: 13.6 ± 3.4 years, 59% female), there was comparable use of Cryo (53%, n=1183) and RF (47%, n=1052). Cryo was more commonly used in patients < 8years of age (p < 0.01). Amongst 60 participating centers, 24 sites (40%) used Cryo predominantly (>90%), while 24 sites (40%) used RF predominantly. Acute success was 98.6% for Cryo and 99% for RF (P = 0.27). AV block was reported in 6 (0.005%) patients with Cyro and 3 (0.003%) with RF (p=0.34), without the need for temporary or permanent pacemaker in either group during the hospital admission. No other MAE occurred in either group. Conclusion: In this largest pediatric study of AVNRT ablation, RF and Cryo demonstrated comparable high acute success and rare documentation of AV block that did not result in temporary or permanent pacing. Longitudinal data are important for further comparison of these two modalities with regard to AVNRT recurrence risk and the need for pacemaker implantation outside of the hospitalization period.