Electrophysiologic Study and Catheter Ablation
Informed consent was obtained, and antiarrhythmic medications stopped the week prior to every procedure. All cases were performed intubated under general endotracheal anesthesia by cardiac anesthesia. Vascular access was attained with placement of sheaths and diagnostic catheters in the right internal jugular, left femoral, and right femoral veins, with sheath and catheter sizes and locations varying based on operator preference. Three-dimensional electroanatomic mapping (EnSite/Velocity NavX, Abbott Laboratories/St Jude Medical, Plymouth, MN; Carto 3, Biosense Webster, Irvine, CA) was utilized for all procedures to minimize the use of fluoroscopy for catheter placement and manipulation. For ablation of left-sided APs, a transseptal or retrograde approach was utilized at the discretion of the electrophysiologist. When necessary, a long sheath was utilized to improve catheter positioning and stability during ablation. In most cases, multiple lesions were required to terminate AP function. During CF cases, the ideal ablation was delivered with > 3 g of force for 60 seconds or a maximum of 400 gs as standard procedure at Children’s Wisconsin. Significant complications related to the ablation procedure were noted.
For each case, overall success and recurrence, total case time, time spent mapping and ablating, number of unsuccessful and consolidation lesions, and total time for each successful lesion were investigated. A successful lesion was defined as the lesion that permanently interrupted the AP while unsuccessful and consolidation lesions were delivered before and after the determined successful lesion, respectively. Overall acute success was defined as the termination of the AP conduction during the procedure and absence of AP conduction during post-ablation testing with isoproterenol and adenosine. Follow-ups typically 4-6 weeks, and occasionally 1-year, post-ablation were reviewed in order to determine long term recurrence, with patients lost to follow-up assumed to not have recurrence.