Use of contact force technology for cardiac arrhythmia ablation in children

Abstract

Introduction: Recently, new techniques for cardiac arrhythmia ablation, such as contact force (CF) technology, have emerged. These catheters provide information about adequate tissue contact for an optimal lesion. In adults, these techniques have shown greater accuracy, reduced arrhythmia recurrence and complications, and higher success rates. However, data in pediatrics are limited. Objective: We aimed to describe the experience of arrhythmia ablation in the pediatric population with CF catheters. Methods: A retrospective cross-sectional descriptive study of all patients younger than 18 years of age undergoing cardiac 3D mapping and ablation with CF between March 2016 and June 2022 was performed. Results: A total of 321 patients were included (51.40% male with a mean age of 12.26 years). The most frequent arrhythmias included supraventricular tachycardia (SVT) mediated by accessory pathways (AP) [atrioventricular reentrant tachycardia (AVRT)] in 82.24%, ventricular arrhythmias (VA) in 11.21% and atrial tachycardia (AT) in 5.92%. The mean procedure time was 2.86 hours (sd 1.2), and the average contact used was 14.33 grams (sd 6.88). The success rate of ablation was 97.82% with a low risk of complications. Conclusion: This is the largest published series of patients under 18 years of age using CF technology. In the pediatric population, CF ablation is a safe procedure with high success rates and can be used for most arrhythmic substrates. The most frequent tachycardia observed in this study was SVT mediated by AP. Contact with 14 grams is safe and yields an excellent outcome in children. The presence of SHA and previous ablation procedures decreased the success rate.