An infant phantom for pediatric pericardial access and electrophysiology training.

Background: Cardiac procedures in infants and children require a high level of skill and dexterity owing to small stature and anatomy. Lower incidence of procedure volume in this population results in fewer clinical opportunities for learning. Simulators have grown in popularity for education and training, though most existing simulators are often cost-prohibitive or model adult anatomy.

Can the 12-lead ECG distinguish RVOT from aortic cusp PVCs in pediatric patients?

Background: The ability to differentiate right ventricular outflow tract (RVOT) from coronary cusp (CC) site of origin (SOO) by 12-lead ECG in pediatric patients may impact efficacy and procedural time. The objective of this study was to predict RVOT versus CC SOO by ECG in pediatric patients.

Methods: Pediatric patients (<21 years) without structural heart disease with RVOT or CC premature ventricular contraction (PVC) ablations performed (2014-2018) were evaluated through multi-institution retrospective review.

Off the pedal: Fluoroless transseptal puncture in pediatric supraventricular tachycardia ablation.

Background: Fluoroless transseptal (TS) puncture may represent the final step toward elimination of fluoroscopy in pediatric supraventricular tachycardia ablation in normal hearts. We aimed to demonstrate the safety and feasibility of fluoroless TS puncture in pediatric patients and compare procedural timing with the fluoroscopic approach.

Methods: We performed a retrospective cohort analysis of all TS procedures performed without fluoroscopy at our institution; fluoroless TS procedures were performed under intracardiac echocardiography (ICE) guidance after the creation of a 3D electroanatomic map and identification of fossa ovalis (FO) on 3D map.

Ablation of the vanishing PVC, facilitated by quantitative morphology-matching software.

Background: Ablation of cardiac arrhythmias in children and teenagers often necessitates the use of anesthesia, which can suppress ventricular arrhythmias (VAs), making it difficult to map the site of origin using activation time (AT). Pace mapping, a technique employed to assist with VA origin localization, depends on subjective comparison of paced and targeted QRS morphology. We assessed the utility of a quantitative approach to paced QRS to VA morphology matching using the PaSo software (Carto 3, Biosense Webster), to localize the VA site of origin.

Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation.

Purpose: Over the past several years, alternative imaging techniques including electroanatomic mapping systems such as CARTO®3 (C3) have been developed to improve anatomic resolution and potentially limit radiation exposure in electrophysiology (EP) procedures. We retrospectively examined the effect of the introduction of C3 on patient radiation exposure during EP studies and ablation procedures at a children's hospital.

Methods: All patients that underwent EP and ablation procedures between January 2012 and August 2015 were included; demographic information, fluoroscopy time (FT), total radiation dose (RAD), and dose-area product (DAP) were collected.