Evaluating the safety and efficacy of zero-fluoroscopy AVNRT catheter ablation in paediatric patients: a retrospective study

Introduction

Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia in paediatric patients, with catheter ablation (CA) for slow pathway modification being the preferred treatment for symptomatic cases.

Traditionally, CA is performed under fluoroscopic guidance, exposing both patients and operators to ionizing radiation. With advancements in electroanatomical mapping, zero-fluoroscopy catheter ablation has emerged as a safe and effective alternative for various arrhythmias. However, data on its safety and efficacy in paediatric patients remain limited.

Purpose

To compare the safety and efficacy of zero-fluoroscopy radiofrequency ablation (RFA) with that of conventional RFA guided by electroanatomical mapping in paediatirc patients with AVNRT.

Methods

We performed a single-centre retrospective cohort study, including all patients under 18 years who underwent CA for AVNRT between 2016 and 2023. Patients with congenital heart disease, severe comorbidities or accessory pathways were excluded.

Results

A total of 56 patients underwent CA during the study period, with a mean age of 15.2 ± 1.9 years. The median weight was 54 kg (IQR 19 kg), and 61% were female. Most patients (89%) were receiving anti-arrhythmic medication, and all had structurally normal hearts.

Zero-fluoroscopy ablation was performed in 43% of cases. Typical AVNRT was observed in 98% of patients. Baseline characteristics were similar between the groups. Procedure duration was slightly longer in the zero-fluoroscopy group (62 vs. 57 minutes, p = 0.021), but acute ablation success was achieved in all cases.

Over a median follow-up of 3.5 years, AVNRT recurrence rates (4.1% vs. 6.36%, p = 0.29) and repeat ablation rates (4.1% vs. 2.8%, p = 0.539) were comparable between groups. No major complications occurred in either group.

Conclusion

Zero-fluoroscopy catheter ablation for AVNRT in paediatric patients is a safe and effective approach, demonstrating high success rates with minimal impact on procedural duration.