Zero Fluoroscopy During Ablation of Right-Sided Supraventricular Tachycardia Substrates in a Pediatric Population - Initial Experience in Taiwan.

Background: Zero fluoroscopy during ablation of arrhythmias has been introduced to reduce radiation exposure. However, the safety, feasibility and efficacy of the technique in pediatric populations have yet to be delineated.

Objectives: To investigate the safety, feasibility and effectiveness of zero fluoroscopic-guided transcatheter ablation of right-sided supraventricular tachycardia substrates in a pediatric population.

Methods: Patients < 20 years of age who received ablation of right-sided accessory pathway-mediated arrhythmia and atrioventricular nodal reentrant tachycardia at our hospital between January 2014 and July 2018 were enrolled, and their medical records were reviewed. Patients undergoing ablations with conventional fluoroscopic guidance were enrolled as the control group, and those undergoing ablations with zero fluoroscopic guidance were enrolled as the study group. Repaired or complex congenital heart disease patients were excluded.

Results: One hundred and two patients (55 male; 47 female) received a total of 109 ablation procedures: 68 procedures in the control group and 41 in the study group. The mean procedure duration was 104.7 ± 65.1 minutes in the control group and 98.6 ± 57.6 minutes in the study group (p = 0.62). The mean fluoroscopy time was 30.9 ± 23.9 minutes in the control group, while all procedures in the study group were performed without fluoroscopy (p < 0.001). In subgroup analysis, the results were similar. Acute procedural success rates were high in both groups (98.5% vs. 97.6%, p = 1.0). The recurrence rate was 11.5% (7/61) in the control group and 7.5% (3/40) in the study group (p = 0.78) at mid-term follow-up.

Conclusions: Using the zero fluoroscopy technique during pediatric ablation procedures for right-sided supraventricular tachycardia substrates is safe and significantly reduces radiation exposure.