Factors associated with fluoroscopy exposure during pediatric catheter ablation utilizing electroanatomical mapping

Abstract

Exposure to ionizing radiation during electrophysiologic procedures in children is believed to increase the risk of future malignancy. Electroanatomical navigation can reduce exposure, but the cohort of children who derive the greatest benefit from this approach is incompletely defined. We sought to determine factors associated with fluoroscopy exposure with conventional catheter ablation versus electroanatomical navigation. A retrospective review of all ablation procedures over a 5-year period during the transition to electroanatomical navigation performed by a single electrophysiologist was performed. Fluoroscopy time >20 min was considered "prolonged." Statistical analysis was performed to determine differences among groups. Two hundred thirty-four subjects underwent catheter ablation during the study period (conventional, n = 127; navigation, n = 107). Mean fluoroscopy decreased from 11.1 to 3.5 min with electroanatomical navigation (p < 0.0001). Overall 53/107 subjects (50 %) undergoing catheter ablation using electroanatomical navigation required no fluoroscopy, of which atrioventricular nodal reentry tachycardia (AVNRT) (n = 23) and right-sided accessory pathways (n = 22) were most common (p = 0.001). Prolonged fluoroscopic exposure was observed for 22/127 (17 %) subjects undergoing conventional fluoroscopy versus 3/107 (3 %) subjects with electroanatomical navigation (p = 0.001) and was not observed after increased experience. Flouroscopy time decreased significantly after the first 20 procedures (p = 0.04). There was no difference in success, complication, or recurrence rate between groups. Electroanatomical navigation significantly reduced fluoroscopic exposure without compromising safety, efficacy, or recurrence. Subjects with AVNRT and right-sided accessory pathways derived the greatest benefit as did those requiring prolonged fluoroscopy by the conventional approach.