Abstract
The Rhythmia™ system (Boston Scientific, Natick, MA, USA) facilitates the rapid acquisition of high-resolution electroanatomical and activation maps. However, there are limited data on its efficacy and safety in pediatric and adult congenital heart disease (CHD) patients. In a retrospective, observational cohort study, adult CHD and pediatric patients followed by pediatric cardiology underwent electrophysiologic study using the Rhythmia™ electroanatomic mapping system. Variables examined included the number of electroanatomical maps required, acquisition time, procedure time, fluoroscopy time, radiation dosage, and rate of recurrent arrhythmia. Twelve consecutive patients, including six male patients (50%), were included with an average age of 27.7 years (range: 11–64 years). Seven (58%) of these patients had a diagnosis of CHD [moderate complexity in two (17%) and great complexity in five patients (42%)] and 10 (83%) patients underwent ablation. A total of 37 high-density maps were created in 12 procedures, with a median of 8,140 mapping points, taking a median of 631 seconds. The median procedure time was 189.5 minutes. The median fluoroscopy time was 0.9 minutes, with eight (67%) patients receiving no fluoroscopy at all. Recurrence occurred in one patient (8%) over a median follow-up duration of 16 months (interquartile range: 12.8–17.3 months). No adverse periprocedural events were recorded. This study suggests the use of high-density electroanatomic mapping in adult CHD patients showed potential for rapid acquisition of highly detailed maps with minimal fluoroscopy time or risk of periprocedural events in the studied population.
Highlights
Innovation in the medical and surgical treatment of congenital and pediatric cardiovascular anomalies has led to a marked improvement in outcomes, with almost 85%of patients surviving into adulthood.[1]
Its adoption is being explored in the catheter ablation of atrial and ventricular arrhythmias in adult populations, with studies indicating a potential to decrease fluoroscopy time, the use of contrast agents, and procedure time.[10]
Patients with a congenital heart disease (CHD) diagnosis or being followed by pediatric electrophysiology with a history of sustained arrhythmia that had been studied using the RhythmiaTM electroanatomic mapping system at the Cleveland Clinic were considered for analysis
Summary
Of patients surviving into adulthood.[1] As the congenital heart disease (CHD) population has grown, cardiac dysrhythmias have proven to be a concerning source of morbidity.[2,3] The heterogeneity of inherent cardiac structural anomalies and procedural history within the CHD population has resulted in substantial anatomic variability and a wide spectrum of dysrhythmia mechanisms.[4,5] Catheter ablation in the CHD population is an accepted therapeutic modality, and accurate mapping of the relevant electrophysiological substrate is crucial for its success.[6,7]. The system has been trialed in pediatric patients with dysrhythmia and adult patients with CHD, albeit only in small studies and case reports, making it difficult to decipher its efficacy.[11,12,13]
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