Fluoroless catheter ablation of accessory pathways in adult and pediatric patients: a single centre experience


Catheter radio-frequency ablation (RFA) and cryo-ablation (CRA) procedures are an effective and safe treatment options for adult and pediatric patients with accessory pathway (AP) mediated tachycardias. Non-fluoroscopic techniques during catheter ablation (CA) procedures reduce potentially harmful effects of radiation. Our aim was to investigate the efficacy and safety of completely fluoroless RFA and CRA procedures in pediatric and adult patients with APs. Consecutive patients with AP-related tachycardia and high risk asymptomatic ventricular pre-excitation were assessed in retrospective analysis. Three-dimensional (3D) electro-anatomical mapping (EAM) and intra-cardiac echocardiography (ICE) were used as principal imaging modalities. Fluoroscopy was not used during any stage of the procedures. Among 116 included patients (22.76 ± 16.1 years, 68 patients < 19 years), 60 had left-sided APs, 16 right-sided APs and 40 septal APs. Altogether, 96 had RFA and 20 CRA procedures. The acute success rates (ASR) of RFA and CRA were 97.9% and 95%, respectively (p = 0.43), with recurrence rates (RR) of 8.33% and 40%, respectively (p < 0.0001). The outcome difference was principally driven by lower RR with RFA in septal APs (9.1% vs. 38.9%, p = 0.025). Pediatric patients with APs (12.21 ± 3.76 years) had similar procedural parameters and outcomes compared to adult patients. There were no procedure-related complications. In adult and pediatric patients with AP-related tachycardias, both CRA and RFA can be effectively and safely performed without the use of fluoroscopy. In addition, RFA resulted in better outcomes compared to CRA.

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Availability of data and materials

Data generated or analyzed during this study is for the most part included in this published article. Additional raw data is available and can be shared upon request to the corresponding author.



Radio-frequency ablation




Accessory pathway


Catheter ablation


Supra-ventricular tachycardia




Three-dimensional electro-anatomic mapping


Intra-cardiac echocardiography


Total procedural time


Total ablation time


Acute success rate


Recurrence rate


Arrhythmia free survival rate




As low as reasonably achievable


Anti-arrhythmic drug








Atrio-ventricular reentry tachycardia


Local activation time


Complication rate


Standard deviation


Body-mass index


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Author information




All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) made substantial contribution to the design of the study, acquisition, analysis and interpretation of data. All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) also actively participated in drafting the manuscript, its final revisions and corrections. All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) read and approved the final version of the manuscript. All authors (MY, NL, TPK, DŽ, KAJ, MT, GM, MJ) agree to be personally accountable for their personal contributions to the manuscript.

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Correspondence to Matevž Jan.

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Conflict of interest

Matevž Jan received honoraria from Biosense Webster and Abbott. Other authors report no conflict of interests.

Ethical approval

The study complies with the Declaration of Helsinki. The fluoroless catheter ablation protocol was approved by The National Medical Ethics Committee (Komisija za medicinsko etiko Republike Slovenije).

Informed consent

All patients (or their parents in case of pediatric patients) gave written informed consent before ablation procedures were performed.

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Yazici, M., Lakič, N., Prolič Kalinšek, T. et al. Fluoroless catheter ablation of accessory pathways in adult and pediatric patients: a single centre experience. Int J Cardiovasc Imaging (2021). https://doi.org/10.1007/s10554-021-02168-5

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  • Accessory pathways
  • Catheter ablation
  • Fluoroless
  • Electro-anatomic mapping system
  • Intra-cardiac echocardiography