ABSTRACT
BACKGROUND
Accessory atrioventricular pathways (AP) are the most common tachycardia substrate
for supraventricular tachycardia (SVT) in the young. Endocardial catheter ablation
of AP may be unsuccessful in up to 5% due to a coronary sinus location.
OBJECTIVE
Data on ablation of accessory pathways within the coronary venous system (CVS) in
the young is sparse.
METHODS
Analysis of feasibility, outcome, and safety in patients ≤18 years with coronary sinus
accessory pathways (CS-AP) and catheter ablation via CVS in a tertiary pediatric electrophysiological
referral center (05/2003-12/2021). Control group adjusted for age, weight, and pathway
location was established from patients of the prospective European Multicenter Pediatric
Ablation Registry who all had endocardial AP ablation.
RESULTS
24 individuals had mapping and intended AP ablation within the CVS (age: 2.7–17.3
years, body weight: 15.0–72.0 kg). Due to proximity to coronary artery, ablation was
withheld in 2/24. Overall procedural success was achieved in 20/22 (90.9%) study patients
and in 46/48 (95.8%) controls. Coronary artery injury after RF ablation was noted
in 2/22 (9%) study patients and in 1/48 (2%) controls. In CVS patients repeat SVT
occurred in 5/22 (23%) during a median follow-up of 8.5 years, 4/5 underwent reablation
resulting in 94.4% overall success. Controls were free from SVT during follow-up of
12 months as defined by registry protocol.
CONCLUSIONS
Success of CS-AP ablation in the young was comparable to endocardial AP-ablation.
Substantial risk of coronary artery injury should be considered when CS-AP ablation
is performed in the young.
Key Words
ABBREVIATIONS:
ABL (Ablation catheter), APAccessory Atrioventricular Pathway (Atrioventricular node), AVRT (Atrioventricular Reentrant Tachycardia), b.w. (Body weight), CHD (Congenital Heart Defect), CA (Coronary Artery), CS (Coronary Sinus), CVS (Coronary Venous System), CS-AP (Coronary Sinus Accessory Pathways), Cryo (Cryoenergy application), EP (Electrophysiological), EPS (Electrophysiological Study), EUROPA (European Multicenter Pediatric Ablation Registry), FU (Follow up), F (French), GVA (Great Cardiac Vein), LAO (Left Anterior Oblique), LCX (Left Circumflex Branch), LCA (Left Coronary Artery), MRI (Magnetic Resonance Imaging), MCV (Middle Cardiac Vein), min (Minute), MV (Mitral Valve), n.a. (Not available), PJRT (Permanent Junctional Reciprocating Tachycardia), RF (Radiofrequency), RAO (Right Anterior Oblique), RCA (Right Coronary Artery), RVOT (Right Ventricular Outflow Tract), SVT (Supraventricular Tachycardia), TV (Tricuspid Valve)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
March 4,
2023
Received in revised form:
March 1,
2023
Received:
February 7,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
Conflict of interest: The authors have no potential conflict of interest or financial support related to the subject of this manuscript.
Ethics approval: This study was reviewed and approved by the ethical committee of the University of Goettingen under file no. 9/7/20 (date: July 13, 2020) and complies with the Declaration of Helsinki.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of Heart Rhythm Society.
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- Ablation Within the Coronary Venous System in Young Patients: A Focus on SafetyHeart Rhythm
- PreviewDespite decades of experience, catheter ablation of an accessory atrioventricular pathway (AP) in the posteroseptal region can still be challenging owing to complex anatomy and the proximity to coronary arteries. This is especially true for APs involving the musculature around the proximal coronary sinus (CS), the middle cardiac vein, or a diverticulum off the CS [1]. The coronary venous system (CVS) can be navigated with high precision guided by a contrast injection in the CS, and the mapping data tend to be relatively unambiguous within these structures, usually displaying a clear AP potential.
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