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.