Abstract
Background
Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia in children and is routinely treated with catheter-based slow-pathway ablation. Procedural safety and radiation exposure reduction are paramount in the pediatric age group, which can be accomplished with 3D electroanatomic (EAM) mapping systems.
Objectives
Evaluation of zero-fluoroscopy radiofrequency (RF) slow-pathway ablation outcomes for AVNRT in patients ≤ 21 years and perform a comparative analysis with the published data on cryoablation, fluoroscopy-guided RF ablation in children, and fluoroless RF ablation in adults.
Methods
We performed a retrospective cohort study of consecutive patients aged ≤ 21 years who underwent RF catheter ablation for AVNRT between June 2016 and September 2025 using the CARTO EAM system.
Results
The cohort included 125 patients (71 females) with a median age of 14.9 years (range 6.0–21) and median weight of 57.4 kg (IQR 48–68). Non-steerable long sheaths were utilized in the majority of patients. Fluoroscopy time was 0 min in all cases. Acute success was achieved in all patients, with no procedural complications. Median procedure time was 121 min (102–151). Among 117/125 patients, with follow-up at a median duration of 36 months, there was no recurrence.
Conclusions
In this consecutive cohort of 125 patients aged ≤ 21 years, zero-fluoroscopy RF slow-pathway modification for AVNRT was performed with complete acute success, no major complications, and no recurrences. Our data support fluoroless RF ablation as an effective and durable strategy for AVNRT in pediatric and young adult patients at experienced centers.