EDITORIAL

Cryoablation, Limited Fluoroscopy, and More KATHRYN K. COLLINS, M.D. From the Pediatric Arrhythmia Center, Children’s Hospital Colorado, University of Colorado, Colorado

The recent article by Karadeniz et al.1 highlights three major areas in pediatric electrophysiology: the use of cryoablation as an appropriate energy source for substrates near the atrioventricular node, no or limited fluoroscopic use during invasive ablation procedures, and a call to take the next step towards multicenter research studies. The first report cryoablation in pediatrics was by Gaita et al. (2004), reporting on a series of four pediatric patients with permanent junctional reciprocating tachycardia.2 Subsequently, several manuscripts reported on procedural success, recurrence rates, and complications from the use of cryoablation for all arrhythmia substrates.3–11 The benefits were touted—catheter adherence, improved safety profile with reversible lesions, and less pain. Then, the focus was quickly narrowed to the use of cryoablation for septal substrates where the safety aspects of cryoablation would be most beneficial and the downside of cryoablation—higher recurrence rates—would be more acceptable. In 2011, a survey of the use of cryoablation in pediatric centers reported that “The overwhelming response (94%) was that cryoablation would only be utilized (for accessory pathways) after mapping the pathway to a high risk area.”12 As to the reasons why some operators were not choosing cryoablation, the primary reason was the high recurrence rates. Other centers continued to utilize cryoablation and identified the following as being associated with improved recurrence rates in cryoablation for accessory pathways: older patient age, accessory pathway location, time to effect of

Cryoablation, limited fluoroscopy, and more.

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