Fluoroless radiofrequency and cryo-ablation of atrioventricular nodal reentry tachycardia in adults and children: a single-center experience

Background Radiofrequency ablation (RFA) and cryo-ablation (CRA) have been traditionally performed with fluoroscopy which exposes patients and medical staff to the potential harmful effects of the X-ray. Therefore, we aimed to assess the feasibility, safety, and effectiveness of RFA and CRA of atrioventricular nodal reentry tachycardia (AVNRT) guided by the three-dimensional (3D) electro-anatomical mapping (EAM) system without the use of fluoroscopy. Methods We analyzed 168 consecutive patients with AVNRT, 62 of whom were under 19 years of age (128 in RFA (age 34.04 +/- 21.0 years) and 40 in CRA (age 39.41 +/- 22.8 years)). All procedures were performed completely without the use of the fluoroscopy and with the 3D EAM system. Results The acute success rates (ASR) of the two ablation methods were very high and similar (for RFA 126/128 (98.4%) and for CRA 40/40 (100%);p = 0.43). Total procedural time (TPT) was similar in RFA and CRA groups (75.04 +/- 42.31 min and 73.12 +/- 30.54 min, respectively;p = 0.79). Recurrence rates (1 (2.5%) and 8 (6.25%);p = 0.35) were similar. There were no complications associated with procedures in either group. In pediatric group, ASR (61/62 (98.38%) and 105/106 (99.05%), respectively;p = 0.69) and TPT (75.16 +/- 42.2 min and 74.23 +/- 38.3 min, respectively;p = 0.88) were similar to the adult group. High ASR was observed with both ablation methods (for RFA 49/50, 98%, and for CRA 12/12, 100%;p = 0.62] with very high arrhythmia-free survival rates (for RFA 98% and for CRA 100%;p = 0.62). Conclusion Based on these results, it can be suggested that fluoroless RFA or CRA guided by the 3D EAM system can be routinely performed in all patients with AVNRT without compromising safety, efficacy, or duration of the procedure.