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    Cryoablation with an 8-mm-Tip -catheter for right-sided accessory pathways in children
    (Wiley-Blackwell, 2016) Tanıdır, İbrahim Cansaran; Ergül, Yakup; Öztürk, Erkut; Dalgıç, Fuheda; Kıplapınar, Neslihan; Tola, Hasan Tahsin; Akdeniz, Celal; Tuzcu, Volkan
    BackgroundCryoablation is increasingly utilized in children because of its safety profile. Recently, larger catheter tips have been more widely used to improve long-term success rates. The aim of this study was to assess the safety and efficacy of 8-mm-tip catheters for cryoablation of right-sided accessory pathways (APs) in children. MethodsElectrophysiological procedures were performed using the EnSite system (St. Jude Medical Inc., St. Paul, MN, USA). ResultsBetween July 2010 and July 2014, 54 patients (mean age: 13.1 3.7 years) underwent cryoablation using an 8-mm-tip catheter. In 18 of 54 (33%) patients where an 8-mm-tip catheter was the first-choice catheter, the success rate was 18 of 18 (100%). There was a history of previous failed attempts or recurrence with radiofrequency ablation and/or 6-mm-tip cryoablation in 36 of 54 (67%) patients. The success rate in these patients was 24 of 36 (67%). No fluoroscopy was used in 34 of 54 procedures. The recurrence rate was six of 42 (14%) during a mean follow-up period of 32 +/- 15 months. In one patient, transient atrioventricular block occurred. ConclusionsCryoablation with an 8-mm-tip catheter for right-sided APs in children who weigh over 40 kg appears to be safe and acutely effective in cases where conventional ablation methods fail and also as a first choice for ablation procedure. However, the recurrence rate still seems to be high.
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    Electroanatomic mapping guided cryoablation of Mahaim pathways in children with limited fluoroscopy exposure
    (Blackwell Publishing, 2015) Öztürk, Erkut; Ergül, Yakup; Cansaran Tanıdır, İbrahim; Akdeniz, Celal; Tola, Hasan Tahsin; Tuzcu, Volkan
    BackgroundThe presence of Mahaim accessory pathways (MAP) with anterograde decremental conduction is a disorder that leads to antidromic atrioventricular reentrant tachycardia. There are rare reports of cryoablation use in MAP. This study aims at sharing our experience with using cryoablation to treat MAP in children. MethodsElectrophysiology study and catheter ablation were performed in 14 patients diagnosed with Mahaim tachycardia between January 2010 and December 2013. Cryoablation was used in nine of the cases. A three-dimensional navigation system with surface electrode patches (EnSite System, St. Jude Medical Inc., St. Paul, MN, USA) was used for all procedures. ResultsThe patients (two girls and seven boys) had a median age of 11.5 years (8-18 years) and a median weight of 67 kg (31-80 kg). Mahaim conduction was localized in the right posterolateral (n = 4), right lateral region (n = 2), right posteroseptal (n = 1), right anterolateral (n = 1), and right anterior (n = 1). A pathway potential was noted in six of nine cases at the tricuspid annulus. Catheter choices and acute success rates were as follows: cryoablation in four (three of four successful), radiofrequency catheter ablation (RFA) and cryoablation in five (successful in four of five). No fluoroscopy was used in six of nine patients. The mean procedure duration was 249 90 minutes. No major complications were observed. The final long-term success rate for cryoablation was seven of nine (78%). ConclusionsCryoablation can be used as a reliable and effective alternative to RFA in the treatment of Mahaim accessory conduction pathways in children. Prospective comparative studies are necessary in order to further evaluate the long-term efficacy of this method.