Irrigated catheter ablation in pediatric ebstein anomaly: acute success and technical perspective from a lower middle income country
L Henao, A Arenas, S CuelloAbstract
Introduction
Ebstein’s anomaly (EA) represents approximately 1% of all congenital heart disease and is frequently associated with accessory pathways and supraventricular tachycardias. Although radiofrequency ablation is an established curative therapy, recurrence rates remain higher in paediatric patients. The introduction of irrigated catheters with contact-force (CF) technology has significantly improved lesion control, safety, and long-term outcomes, however, in Latin America the evidence remains limited.
Objective
To describe the procedural characteristics and outcomes following irrigated catheter ablation in paediatric patients with EA over a decade of single-centre experience.
Methods
A retrospective cohort was conducted, including all patients aged <18 years with EA who underwent irrigated catheter ablation using CF technology between 2013 and 2023 at a national congenital heart disease referral centre in a lower–middle income country. Age, sex and Procedural Technical Characteristics (fluoroscopy time, radiation dose, procedure duration, use of CF technology, and use of intracardiac echocardiography [ICE]) were collected. Outcomes included acute procedural success, defined as the absence of arrhythmia recurrence, and the immediate procedure-related complications. The study was approved by the institutional ethics committee.
Results
Thirty-six patients were included. The median age was 12 years and 47.22% were male. The median procedure duration was 191.5 minutes, with a minimum of 105 minutes. The maximum fluoroscopy time was 13 minutes. ICE was used in 88.89% of cases and CARTO navigation system was most commonly used. Acute procedural success was achieved in 94.44% (n = 34). No major intraprocedural complications were observed. Overweight patients demonstrated longer procedure times (median 222 minutes; IQR 186–278) compared with those with appropriate weight for height.
Conclusion
In our cohort, conducted in a Latin American resource-limited setting, This procedure proved to be safe and effective, with a high acute success rate and minimal radiation exposure in arrhythmia ablation for paediatric patients with EA. The younger age of patients in our cohort, compared with other populations, suggests a greater symptomatic burden that may prompt earlier intervention. Fluoroscopy times were low (median 5 minutes), highlighting the efficiency of ICE-guided procedures and showing that international standards of safety and precision can be achieved even in low-resource environments. Overweight appeared to correlate with longer procedure duration; however, this association requires further investigation with larger sample sizes. These findings highlight the value of advanced paediatric electrophysiology in Latin America. Important limitations should be acknowledged; further multicentre, prospective studies in lower-middle-income countries are warranted to assess safety, efficacy, both early and late outcomes.Clinical CharacteristicsProcedural Technical Characteristics