CORONARY SINUS ABLATION IN PEDIATRIC PATIENTS WITH SUPRAVENTRICULAR ARRHYTHMIAS; EIGHT YEARS SINGLE-CENTER EXPERIENCE

AEPC 2022 - 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology , Geneve, İsviçre, 25 - 28 Mayıs 2022, ss.141

CORONARY SINUS ABLATION IN PEDIATRIC PATIENTS WITH SUPRAVENTRICULAR ARRHYTHMIAS;

EIGHT YEARS SINGLE-CENTER EXPERIENCE

Hacer Kamali, Hasan Candas Kafali, Bahar Caran, Ayse Sulu, Alper Guzaltas, Yakup Ergul

Department of Pediatric Cardiology, Saglik Bilimleri University M. Akif Ersoy Thoracic and

Cardiovascular Surgery Center, Istanbul, Turkey

BACKGROUND AND AIM: Intracoronary sinus ablations have been performed for various epicardial

arrhythmical substrates. This study reveals our experience with supraventricular tachyarrhythmia

(SVT) ablations into coronary sinus.

METHODS: This retrospective study includes all patients who underwent SVT ablation into coronary

sinus from October 2013 to October 2021 in a single center. Clinical presentation, type of arrhythmia

causing tachycardia, ablation procedure and outcomes were recorded.

RESULTS: A total of 27 patients were included in the study. The total number of patients who

underwent ablation in 8 years at the study center was 1450. The median age and weight of the

patients were 11 years (range 4.3 to 18 years) and 43.5 kg (range16 to 110 kg). Nineteen of the cases

(70,4%) were diagnosed with Wolff–Parkinson–White Syndrome (WPW) (9/19 cases had

supraventricular tachycardia (SVT), 8/19 were asymptomatic WPW, 2/19 cases presented with the

rapid transition of atrial fibrillation resulting with syncope). Four (14.8%) cases of SVT were

diagnosed with concealed accessory pathway, 2 (7.4%) cases with focal atrial tachycardia (FAT), 2

(7.4%) cases with permanent junctional reciprocating tachycardia (PJRT). Ten (37%) patients had a

previous history of unsuccessful ablation in other centers. A negative delta wave was noteworthy,

especially in lead II in 11/19 (58%) cases, and coronary sinus diverticulum was detected in these

cases. Among those with manifest AP (19 cases), 15 (79%) APs were risky. All those APs were

adenosine unresponsive. Fluoroscopy was used in 25/27 (92,5%) cases. Median fluoro time was 9,45

minute (min 1 max 34,5). Radiofrequency catheter (RF) ablation was performed in 25/27 (92,5%)

cases, and 16/25 (64%) of them were irrigated RF catheters. Cryoablation was established in

4/27(14,8 %) cases, and 2 of them were subsequently intervened with RF catheter ablation. The

median procedure time was 186 min (min 105 max 290 min), and the procedure was successful in all

(27/27, 100%). Complication or recurrence was not observed during follow-up.

CONCLUSIONS: Catheter ablation of supraventricular tachyarrhythmias can be accomplished

effectively and safely within the coronary sinus when endocardial approaches are unsuccessful. CS

diverticula should be suspected in patients with manifest posteroseptal accessory pathways with a

previously failed ablation and typical electrocardiographic signs.

Keywords: Coronary sinus ablation, supraventricular arrhythmias, radiofrequency catheter ablation,

cryoablation

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