Skip to main content
SpringerLink
Log in

The Demise of Fluoroscopy in Pediatric Electrophysiology

  • Chapter
  • First Online:
Cardiac Electrophysiology Without Fluoroscopy

  • 403 Accesses

Abstract

Electrophysiology and catheter ablation in the pediatric population is currently undergoing a rapid evolution. The availability of three-dimensional mapping systems has lead to a significant reduction in radiation exposure for patients and staff. As the technology continues to improve, there is opportunity for radiation to be eliminated from routine procedures. This chapter will review the history of the mapping systems that have been at the forefront thus far, as well as outline approaches to ablating specific arrhythmias without fluoroscopy, from the simplest to the most difficult. Finally, important reasons to pursue a zero-fluoroscopy approach in this population will be discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kean AC, LaPage MJ, Yu S, Dick M 2nd, Bradley DJ. Patient and procedural correlates of fluoroscopy use during catheter ablation in the pediatric and congenital electrophysiology lab. Congenit Heart Dis. 2015;10(3):281–7.

    Article  PubMed  Google Scholar 

  2. Beels L, Bacher K, De Wolf D, Werbrouck J, Thierens H. Gamma-H2AX foci as a biomarker for patient X-ray exposure in pediatric cardiac catheterization: are we underestimating radiation risks? Circulation. 2009;120(19):1903–9.

    Article  CAS  PubMed  Google Scholar 

  3. Limacher MC, Douglas PS, Germano G, et al. ACC expert consensus document. Radiation safety in the practice of cardiology. American college of cardiology. J Am Coll Cardiol. 1998;31(4):892–913.

    Article  CAS  PubMed  Google Scholar 

  4. Broga D. Ionizing radiation exposure of the population of the united states. National Council on Radiation. 1st edn. Wiley: Hoboken, NJ: 2009. https://doi.org/10.1118/1.3245881.

    Article  Google Scholar 

  5. Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP society, radiofrequency catheter ablation registry. Am J Cardiol. 1997;80(11):1438–43.

    Article  CAS  PubMed  Google Scholar 

  6. Van Hare GF, Javitz H, Carmelli D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol. 2004;15(7):759–70.

    Article  PubMed  Google Scholar 

  7. Clay MA, Campbell RM, Strieper M, Frias PA, Stevens M, Mahle WT. Long-term risk of fatal malignancy following pediatric radiofrequency ablation. Am J Cardiol. 2008;102(7):913–5.

    Article  PubMed  Google Scholar 

  8. Gellis LA, Ceresnak SR, Gates GJ, Nappo L, Pass RH. Reducing patient radiation dosage during pediatric SVT ablations using an “ALARA” radiation reduction protocol in the modern fluoroscopic era. Pacing Clin Electrophysiol. 2013;36(6):688–94.

    Article  PubMed  Google Scholar 

  9. Drago F, Silvetti MS, Di Pino A, Grutter G, Bevilacqua M, Leibovich S. Exclusion of fluoroscopy during ablation treatment of right accessory pathway in children. J Cardiovasc Electrophysiol. 2002;13(8):778–82.

    Article  PubMed  Google Scholar 

  10. Pass RH, Gates GG, Gellis LA, Nappo L, Ceresnak SR. Reducing patient radiation exposure during paediatric SVT ablations: use of CARTO(R) 3 in concert with “ALARA” principles profoundly lowers total dose. Cardiol Young. 2015;25(5):963–8.

    Article  PubMed  Google Scholar 

  11. Miyake CY, Mah DY, Atallah J, et al. Nonfluoroscopic imaging systems reduce radiation exposure in children undergoing ablation of supraventricular tachycardia. Heart Rhythm. 2011;8(4):519–25.

    Article  PubMed  Google Scholar 

  12. Clark BC, Sumihara K, McCarter R, Berul CI, Moak JP. Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation. J Interv Card Electrophysiol. 2016;46(2):183–9.

    Article  PubMed  Google Scholar 

  13. Tuzcu V. A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system. Pacing Clin Electrophysiol. 2007;30(4):519–25.

    Article  PubMed  Google Scholar 

  14. Smith G, Clark JM. Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping. Pacing Clin Electrophysiol. 2007;30(4):510–8.

    Article  PubMed  Google Scholar 

  15. Ergul Y, Tola HT, Kiplapinar N, Akdeniz C, Saygi M, Tuzcu V. Cryoablation of anteroseptal accessory pathways in children with limited fluoroscopy exposure. Pediatr Cardiol. 2013;34(4):802–8.

    Article  PubMed  Google Scholar 

  16. Scaglione M, Ebrille E, Caponi D, et al. Zero-fluoroscopy ablation of accessory pathways in children and adolescents: CARTO3 electroanatomic mapping combined with RF and cryoenergy. Pacing Clin Electrophysiol. 2015;38(6):675–81.

    Article  PubMed  Google Scholar 

  17. Ceresnak SR, Nappo L, Janson CM, Pass RH. Tricking CARTO: cryoablation of supraventricular tachycardia in children with minimal radiation exposure using the CARTO3 system. Pacing Clin Electrophysiol. 2016;39(1):36–41.

    Article  PubMed  Google Scholar 

  18. Scaglione M, Ebrille E, Caponi D, et al. Single center experience of fluoroless AVNRT ablation guided by electroanatomic reconstruction in children and adolescents. Pacing Clin Electrophysiol. 2013;36(12):1460–7.

    Article  PubMed  Google Scholar 

  19. Alvarez M, Tercedor L, Almansa I, et al. Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance. Heart Rhythm. 2009;6(12):1714–20.

    Article  PubMed  Google Scholar 

  20. Gist K, Tigges C, Smith G, Clark J. Learning curve for zero-fluoroscopy catheter ablation of AVNRT: early versus late experience. Pacing Clin Electrophysiol. 2011;34(3):264–8.

    Article  PubMed  Google Scholar 

  21. Dieks JK, Muller MJ, Schneider HE, et al. Catheter ablation of pediatric focal atrial tachycardia: ten-year experience using modern mapping systems. Pediatr Cardiol. 2016;37(3):459–64.

    Article  PubMed  Google Scholar 

  22. Zambito MP, Samuel BP, Vettukattil JJ, Ratnasamy C. Fluoroless catheter ablation of intraatrial reentrant tachycardia status post fontan procedure: fluoroless catheter ablation in fontan patient. Int J Cardiol. 2015;201:126–8.

    Article  PubMed  Google Scholar 

  23. Clark J, Bockoven JR, Lane J, Patel CR, Smith G. Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing Clin Electrophysiol. 2008;31(3):283–9.

    Article  PubMed  Google Scholar 

  24. Mah DY, Miyake CY, Sherwin ED, et al. The use of an integrated electroanatomic mapping system and intracardiac echocardiography to reduce radiation exposure in children and young adults undergoing ablation of supraventricular tachycardia. Europace. 2014;16(2):277–83.

    Article  PubMed  Google Scholar 

  25. Jan M, Zizek D, Rupar K, et al. Fluoroless catheter ablation of various right and left sided supra-ventricular tachycardias in children and adolescents. Int J Cardiovasc Imaging. 2016;32(11):1609–16.

    Article  PubMed  Google Scholar 

  26. Nagaraju L, Menon D, Aziz PF. Use of 3D electroanatomical navigation (CARTO-3) to minimize or eliminate fluoroscopy use in the ablation of pediatric supraventricular tachyarrhythmias. Pacing Clin Electrophysiol. 2016;39(6):574–80.

    Article  PubMed  Google Scholar 

  27. Wan G, Shannon KM, Moore JP. Factors associated with fluoroscopy exposure during pediatric catheter ablation utilizing electroanatomical mapping. J Interv Card Electrophysiol. 2012;35(2):235–42.

    Article  PubMed  Google Scholar 

  28. Von Bergen NH, Bansal S, Gingerich J, Law IH. Nonfluoroscopic and radiation-limited ablation of ventricular arrhythmias in children and young adults: a case series. Pediatr Cardiol. 2011;32(6):743–7.

    Article  Google Scholar 

  29. Ozyilmaz I, Ergul Y, Akdeniz C, Ozturk E, Tanidir IC, Tuzcu V. Catheter ablation of idiopathic ventricular tachycardia in children using the EnSite NavX system with/without fluoroscopy. Cardiol Young. 2014;24(5):886–92.

    Article  PubMed  Google Scholar 

  30. Akdeniz C, Gul EE, Celik N, Karacan M, Tuzcu V. Catheter ablation of idiopathic right ventricular arrhythmias in children with limited fluoroscopy. J Interv Card Electrophysiol. 2016;46(3):355–60.

    Article  PubMed  Google Scholar 

  31. Giaccardi M, Chiodi L, Del Rosso A, Colella A. ‘Zero’ fluoroscopic exposure for ventricular tachycardia ablation in a patient with situs viscerum inversus totalis. Europace. 2012;14(3):449–50.

    Article  PubMed  Google Scholar 

  32. Bigelow AM, Arnold BS, Padrutt GC, Clark JM. Non-fluoroscopic cardiac ablation of neonates with CHD. Cardiol Young. 2017;27(3):592–6.

    Article  PubMed  Google Scholar 

  33. Stec S, Sledz J, Mazij M, et al. Feasibility of implementation of a “simplified, no-X-ray, no-lead apron, two-catheter approach” for ablation of supraventricular arrhythmias in children and adults. J Cardiovasc Electrophysiol. 2014;25(8):866–74.

    Article  PubMed  Google Scholar 

  34. Roguin A, Goldstein J, Bar O, Goldstein JA. Brain and neck tumors among physicians performing interventional procedures. Am J Cardiol. 2013;111(9):1368–72.

    Article  PubMed  Google Scholar 

  35. Szumowski L, Szufladowicz E, Orczykowski M, et al. Ablation of severe drug-resistant tachyarrhythmia during pregnancy. J Cardiovasc Electrophysiol. 2010;21(8):877–82.

    PubMed  Google Scholar 

  36. Wu H, Ling LH, Lee G, Kistler PM. Successful catheter ablation of incessant atrial tachycardia in pregnancy using three-dimensional electroanatomical mapping with minimal radiation. Intern Med J. 2012;42(6):709–12.

    Article  CAS  PubMed  Google Scholar 

  37. Hogarth AJ, Graham LN. Normal heart ventricular tachycardia associated with pregnancy: successful treatment with catheter ablation. Indian Pacing Electrophysiol J. 2014;14(2):79–82.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Raman AS, Sharma S, Hariharan R. Minimal use of fluoroscopy to reduce fetal radiation exposure during radiofrequency catheter ablation of maternal supraventricular tachycardia. Tex Heart Inst J. 2015;42(2):152–4.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bigelow AM, Crane SS, Khoury FR, Clark JM. Catheter ablation of supraventricular tachycardia without fluoroscopy during pregnancy. Obstet Gynecol. 2015;125(6):1338–41.

    Article  PubMed  Google Scholar 

  40. Chen G, Sun G, Xu R, et al. Zero-fluoroscopy catheter ablation of severe drug-resistant arrhythmia guided by ensite NavX system during pregnancy: two case reports and literature review. Medicine (Baltimore). 2016;95(32):e4487.

    Article  Google Scholar 

  41. Prolic Kalinsek T, Jan M, Rupar K, Razen L, Antolic B, Zizek D. Zero-fluoroscopy catheter ablation of concealed left accessory pathway in a pregnant woman. Europace. 2017;19(8):1384.

    Article  PubMed  Google Scholar 

  42. Kozluk E, Piatkowska A, Kiliszek M, et al. Catheter ablation of cardiac arrhythmias in pregnancy without fluoroscopy: a case control retrospective study. Adv Clin Exp Med. 2017;26(1):129–34.

    Article  PubMed  Google Scholar 

  43. Rossi L, Penela D, Villani GQ. Intracardiac echocardiography catheter-guided zero fluoroscopy transeptal puncture technique for ablation of left-sided accessory pathway in a pregnant woman. Europace. 2017;19(11):1825.

    Article  PubMed  Google Scholar 

  44. Lahiri A, Srinath SC, Chase D, Roshan J. Zero fluoroscopy radiofrequency ablation for typical atrioventricular nodal reentrant tachycardia (AVNRT). Indian Pacing Electrophysiol J. 2017;17(6):180–2.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bigelow AM, Smith PC, Timberlake DT, et al. Procedural outcomes of fluoroless catheter ablation outside the traditional catheterization lab. Europace. 2017;19(8):1378–84.

    Article  PubMed  Google Scholar 

  46. Ceresnak SR, Dubin AM, Kim JJ, et al. Success rates in pediatric WPW ablation are improved with 3-dimensional mapping systems compared with fluoroscopy alone: a multicenter study. J Cardiovasc Electrophysiol. 2015;26(4):412–6.

    Article  PubMed  Google Scholar 

  47. Tuzcu V. Significant reduction of fluoroscopy in pediatric catheter ablation procedures: long-term experience from a single center. Pacing Clin Electrophysiol. 2012;35(9):1067–73.

    Article  PubMed  Google Scholar 

  48. Solimene F, Donnici G, Shopova G, et al. Trends in fluoroscopy time during radiofrequency catheter ablation of supraventricular tachycardias. Int J Cardiol. 2016;202:124–5.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Amee M. Bigelow

  2. Division of Cardiology, Department of Pediatrics, Heart Center, Akron Children’s Hospital, Akron, OH, USA

    John M. Clark

Authors
  1. Amee M. Bigelow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John M. Clark
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John M. Clark .

Editor information

Editors and Affiliations

  1. Department of Cardiac, Thoracic Vascular Sciences and Public Health, The University of Padua, Padua, Italy

    Riccardo Proietti

  2. Huazhong University of Science and Technology Tongji Hospital, Tongji Medical College, Wuhan, China

    Yan Wang

  3. Peking Union Medical College Hospital, National Center for Cardiovascular Disease, Beijing, China

    Yan Yao

  4. The First Affiliated Hospital of Guangxi Medical University , Nanning, China

    Guo Qiang Zhong

  5. Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China

    Shu Lin Wu

  6. Université de Sherbrooke , Sherbrooke, QC, Canada

    Félix Ayala-Paredes

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bigelow, A.M., Clark, J.M. (2019). The Demise of Fluoroscopy in Pediatric Electrophysiology. In: Proietti, R., Wang, Y., Yao, Y., Zhong, G., Lin Wu, S., Ayala-Paredes, F. (eds) Cardiac Electrophysiology Without Fluoroscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-16992-3_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16992-3_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16991-6

  • Online ISBN: 978-3-030-16992-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation