Radiofrequency ablation versus cryotherapy for pediatric atrioventricular nodal re-entrant tachycardia: a systematic review and meta-analysis
M Joseph, M Murali Krishna, X Jacquemyn, Z Akman, C Ezenna, M Mouslmani, R Rossi, G Babapour, A Nouri, M Nanna, S KuttyAbstract
Background
Atrioventricular nodal re-entrant tachycardia (AVNRT) is one of the most common types of supraventricular tachycardia in the pediatric population. Catheter ablation of the slow pathway can be accomplished using radiofrequency ablation (RFA) or cryotherapy; however, the optimal energy modality in pediatric patients remains debated.
Purpose
We aimed to compare the safety and efficacy of RFA with cryotherapy for catheter ablation of AVNRT in the pediatric population.
Methods
PubMed, Scopus, and Cochrane Central databases were systematically searched for studies comparing RFA with cryotherapy for AVNRT in pediatric patients from inception through February 2026. The outcomes of interest included acute success, atrioventricular (AV) block, recurrence, procedure time, fluoroscopy time, and ablation time. A random effects model was used to generate risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs).
Results
The systematic review identified 7 studies, constituting 2747 patients, of whom 47.9% underwent RFA for AVNRT. The risk of recurrence (RR 0.37; 95%CI 0.23-0.62; p<0.001; I2=0%) was significantly lower with RFA compared with cryotherapy. (Figure 1) Fluoroscopy time (MD 2.33; 95%CI 1.91 to 2.74; p<0.01; I2=29%) was longer with RFA. (Figure 1) However, ablation time (MD -18.33; 95%CI -30.6 to -6.06; p<0.01; I2=95%) and procedure time (MD -35.64; 95%CI -49.78 to -21.5; p<0.01; I2=68%) were significantly shorter with RFA compared with cryotherapy. (Figure 2) Acute success rates and incidence of AV block were comparable between the groups.
Conclusion
In pediatric patients undergoing catheter ablation for AVNRT, RFA was associated with a significantly lower recurrence rate compared with cryotherapy. Although fluoroscopy time was slightly longer, RFA resulted in shorter ablation and overall procedure times. These findings support RFA as an effective strategy for slow-pathway ablation in the pediatric population.Figure 1Figure 2