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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Pediatric Cardiology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1527768

Radiofrequency Ablation versus Cryoablation for Pediatric Atrioventricular Nodal Reentrant Tachycardia in the Era of Threedimensional Electroanatomical Mapping

Provisionally accepted
Yao-Wei Chan Yao-Wei Chan 1Chieh-Mao Chuang Chieh-Mao Chuang 1,2*Pi-Chang Lee Pi-Chang Lee 1I Hsin Tai I Hsin Tai 1,3,4Peng Ying Hsuan Peng Ying Hsuan 1,5Wen-Po Fan Wen-Po Fan 1,6Yu-Shin Lee Yu-Shin Lee 7Ming-Chih Lin Ming-Chih Lin 1,8Sheng-Lin Jan Sheng-Lin Jan 1,8Yun-Ching Fu Yun-Ching Fu 1,8Shih-ann Chen Shih-ann Chen 10,9
  • 1 Division of Pediatric Cardiology, Children's Medical Center, Taichung Veterans General Hospital, Taichung City, Taiwan
  • 2 Division of Cardiology, Department of Internal Medicine, Asia University Hospital, Taichung, Taiwan
  • 3 Department of Cardiology, China Medical University Children’s Hospital, Taichung, Taiwan
  • 4 Department of Pediatrics, College of Medicine, China Medical University, Taichung, Taiwan
  • 5 Division of Pediatric Cardiology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
  • 6 Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
  • 7 Division of Pediatric Cardiology, Department of Pediatrics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
  • 8 Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
  • 9 Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
  • 10 Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taipei County, Taiwan

The final, formatted version of the article will be published soon.

    Background: Cryoablation for pediatric atrioventricular nodal reentry tachycardia (AVNRT) is favored for reducing conduction system injury compared to radiofrequency (RF) ablation. The safety advantage of cryoablation over RF ablation primarily results from studies conducted without a threedimensional electroanatomical mapping (3D EAM) system. Currently, 3D EAM systems offer precise and efficient guidance, improving safety and outcomes. This study compares RF ablation and cryoablation using a 3D EAM system for pediatric AVNRT treatment. Methods: A retrospective study enrolled consecutive pediatric patients with AVNRT who underwent RF ablation (RF group) or cryoablation (Cryo group) guided by a 3D EAM system at multiple centers from July 2018 to January 2024.Results: Among 95 patients, 69 received RF ablation and 26 received cryoablation. Recurrence rates were 2.9% in the RF group and 0% in the Cryo group (p>0.99), with no difference in AVNRT-free survival. No major complications, such as permanent atrioventricular (AV) block, were observed. The minor complication rates, including transient AV block, did not differ significantly (14.5% vs. 11.5%, p>0.99). The RF group had a significantly shorter procedure time (111 vs. 153.5 minutes, p=0.005). Ablation outside the low Koch triangle and cryoablation were independently associated with longer procedure times. The procedure time decreased significantly in the recent 50% of RF ablation cases, but not in cryoablation cases.With 3D EAM guidance, both RF ablation and cryoablation are considered safe and effective for pediatric AVNRT. RF ablation is more efficient with a shorter procedure time after increasing experience.

    Keywords: pediatric, Atrioventricular nodal reentrant tachycardia, Radiofrequency ablation, Cryoablation, Electroanatomical mapping systems

    Received: 13 Nov 2024; Accepted: 14 Jan 2025.

    Copyright: © 2025 Chan, Chuang, Lee, Tai, Ying Hsuan, Fan, Lee, Lin, Jan, Fu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Chieh-Mao Chuang, Division of Pediatric Cardiology, Children's Medical Center, Taichung Veterans General Hospital, Taichung City, Taiwan

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.