Contact force sensing radiofrequency catheter ablation guided by electroanatomic mapping in pediatric patients with permanent junctional reciprocating tachycardia: A case series

Limited data are available on the use of irrigated contact force (CF) catheters for radiofrequency (RF) ablation permanent junctional reciprocating tachycardia (PJRT) in children. We considered five consecutive pediatric patients with diagnosis PJRT who underwent RF CF catheter guided by electroanatomic mapping, obtaining a low number pulses and minimal fluoroscopy exposure. High values not necessary to obtain effective lesions successful ablation. Permanent is rare type supraventricular (SVT) Because disappointing outcomes from medications rate spontaneous resolution, (CA) has become treatment choice PJRT.1 Novel technical advances, such as 3D mapping systems (EAMS) tip sensing (CFS) technology, have been developed procedures adult patients, increasing success rates reducing x-ray these technologies CA Five (mean age 12 ± 3.3 years) near-zero (NF-RFCA) at Pediatric Congenital Electrophysiology Laboratory our Unit between January 2017 2023. Clinical procedural summarized Table 1. All had no underlying structural abnormalities. was almost incessant two despite medical therapy. In others, it paroxysmal frequent recurrences. (EP) study performed under general anesthesia all cases. half-lives wash-out therapy were respected. Right femoral vein standard vascular access using sheaths. used fluoroscopic approach Carto 3 EAMS (Biosense Webster). CFS (SmartTouch ThermoCool 3.5 mm, Biosense Webster) inserted first start zero navigation accurate right atrium, identifying atrioventricular (AV) node coronary sinus (CS) ostium. encountered significant maneuvering difficulties chambers, including entrance CS. After completing reconstruction, diagnostic EAM guidance: one quadripolar record His bundle electrogram decapolar explore At EP study, present baseline (#4 #5). easily inducible conventional pacing maneuvers without infusion isoproterenol. diagnosed according criteria consistent literature mapped1: narrow QRS negative P waves inferior leads; 1:1 AV relationship long VA interval; anterograde conduction; presence slow decremental retroconduction during ventricular pacing; reset retrograde atrial activation or termination single premature extrastimulus introduced when refractory. delivered earliest where an accessory pathway (AP) potential visible. only released value 3-20 g, setting power 20 30 W irrigation flow rate. If stopped 10 s energy delivery, lesion same point until total time 60 s, typical workflow AP RFCA (after least 15 minutes) both stimulation before after intravenous isoproterenol, along evidence excusive conduction over node. case recurrence, remapped further shots delivered. The localized CS ostium cases (Figures 1-3). required elimination 2.2 0.8, mean 9.4 2.7 g. Acute achieved complications. One patient transient irritative rhythm delivery resolution. discharged free antiarrhythmic next day. follow-up 37.8 16.5 months. No recurrences occurred. can be effectively employed SVT, lower forces compared SVT adults.2-5 It demonstrated that higher unsuccessful children.2 However, could enhance risk complications, damage system arteries, perforation cardiac tamponade. Most APs sustain arrhythmia placed endocardial surface near ostium.1 There clinical subclinical posteroseptal pathways proximal CS, particularly close terminal branch artery left circumflex artery. Therefore, should caution, avoiding high values. specific indications lacking, we maintaining operators' experience previous reports.2-5 Cruz-Baquero et al.3 described large population children undergoing catheters. They defined 14.3 6.8 g safe parameter obtained ~12 6 FEDERATION Study,4 described. 7.7 6.6 NF-RFCA showed feasible series, Our suggests because transmurality usually ablate PJRT. preliminary experience, observed complications increased CFs used, compromising effectiveness. real-time about electrode-tissue useful maintain reduce monitoring, especially and/or weight. Further studies needed define ideal demonstrate superiority definitively treat patients. authors specially thank Adult Heart Disease nursing staff head nurses Mrs. Assunta Carandente, Monica Iacona, Annunziata Orefice their essential contribution support high-quality care manager Dr. Gabriella Piccolo, Nadia Puzone, Cecilia Spinelli Barrile, Tiziana Varriale collection. also Eng. Veronica Raniello Sara Ferullo image funding sources given this study. report financial relationships construed conflict interest. This series complied Declaration Helsinki its later amendments. Informed consent patient's parents/legal guardians. N/A. findings corresponding author, upon reasonable request.