Volkan Tuzcu

A Nonfluoroscopic Approach for Electrophysiology and Catheter Ablation Procedures Using a Three‐Dimensional Navigation System

Background: Three‐dimensional (3D) electroanatomical navigation systems decrease the fluoroscopy time of electrophysiology and ablation procedures. The aim of this study was to assess the safety and efficacy of a complete nonfluoroscopic approach for electrophysiologic studies and right‐sided catheter ablations for supraventricular tachycardia in patients with normal cardiac anatomy using a 3D, surface electrode‐based navigation system (NavX™, St. Jude Medical, St. Paul, MN, USA).

Cryoablation of Accessory Pathways in Children

Background: Cryoablation is utilized for septal tachycardia substrates due its safety. Considering the recent studies which reveal coronary artery stenosis related to radiofrequency ablation (RFA) in children, cryoablation may offer advantages for nonseptal accessory pathways (APs) as well. The aim of this study was to investigate the efficacy and safety of cryoablation of APs in children.

Significant Reduction of Fluoroscopy in Pediatric Catheter Ablation Procedures: Long‐Term Experience from a Single Center

Background: Traditionally fluoroscopy has been used for navigation of catheters during electrophysiological procedures. Recent advances in electroanatomic mapping technologies resulted in a decrease and even in elimination of fluoroscopy exposure during these procedures.

Subxiphoid Approach to Epicardial Implantation of Implantable Cardioverter Defibrillators in Children

Epicardial implantation of implantable cardioverter defibrillators (ICDs) is considered in the presence of intracardiac shunt, venous access issue, or small body size. We report our experience with epicardial ICD coil implantation using a minimally invasive method.

Resolution of T-wave oversensing with implantable cardioverter defibrillator generator replacement in an adolescent

Inappropriate delivery of therapy due to T‐wave oversensing is a frequent complication of intracardiac cardioverter defibrillators (ICD). A 16‐year‐old adolescent with congenital long QT syndrome type 3 underwent single‐chamber implantable cardioverter defibrillator (ICD) (EnTrust VR, Medtronic Inc., Minneapolis, MN, USA) implantation. He received two appropriate and four inappropriate shocks. The inappropriate shocks were due to T‐wave oversensing. Following the replacement of ICD with a different brand generator (Vitality 2 VR, Boston Scientific Inc., Natick, MA, USA), no more T‐wave oversensing is noted. Proper filtering is imperative in ICDs in order to prevent T‐wave oversensing‐related inappropriate delivery of therapy.

Implantation of SelectSecure™ Leads in Children

Conventional pacemaker leads have a lumen to help facilitate lead implantation and extraction. To achieve a small diameter (4.1 Fr), a bipolar, fix-screw, steroid-eluting, lumenless lead (SelectSecureTM lead, model 3830, Medtronic, Minneapolis, MN, USA) was developed.1,2 The small diameter of the SelectSecureTM lead is accomplished with the removal of the stylet lumen. Removal of the lumen may also facilitate the lead extraction since a locking stylet is not going to be needed. Because of the lack of lumen, the delivery of this lumenless lead is performed using an 8.4-Fr deflectable catheter. Following advancement of the SelectSecureTM catheter to the desired location along with the dilator and the guidewire, the lead is fixated at the target site with rotation of the lead body. A recent multicenter study revealed the safety and efficacy of this new lead design.1 At 3-month follow-up, atrial lead complication rate was 3% and ventricular lead complication rate was 5.9%. The lead dislodgement was the most common complication for both leads. The author noted a decreased complication rate following training sessions held to aim at improving implant techniques. Because of the durability and lower thresholds associated with endocardial pacing, this approach is preferred to epicardial pacing by most pediatric centers in the absence of precluding factors such as intracardiac shunts or young age. Silvetti et al. recently reported their 20-year experience with pediatric cardiac pacing and demonstrated significantly higher epicardial lead failures compared to the endocardial leads (31% vs 9%).3 Despite its advantages, transvenous pacemaker implantations have certain limitations in children. One major concern is venous obstruction.4 Pacemaker leads with smaller body design may help in preservation of venous patency in children. A recent study by Bar-Cohen et al. demonstrated venous obstruction of variable degrees in 25% of chronically paced children.5 One of the interesting findings of that

Assessment of atrioventricular conduction following cryoablation of atrioventricular nodal reentrant tachycardia in children.

Early‐onset transient atrioventricular block (AVB) is a rare occurrence following cryoablation of atrioventricular nodal reentrant tachycardia (AVNRT), despite lack of any AVB at the end of the procedure. The purpose of this prospective study was to assess AVB shortly after successful cryoablation of AVNRT in children.

Intrathoracic implantation of a dual-chamber pacemaker in a preterm infant with congenital AV block.

Congenital complete atrioventricular block can be concomitant with congenital heart diseases or maternal connective tissue disorders like systemic lupus erythematosus and Sjögrens syndrome. Such patients may require implantation of a permanent pacemaker due to ventricular dysfunction. While many methods of pacemaker implantation have been tested, one that is optimal for low birth weight infants remains to be determined. We present a preterm infant with maternal Sjögrens syndrome with congenital heart block and describe the technique for implantation of an intrathoracic dual‐chamber pacemaker. doi: 10.1111/jocs.12068 (J Card Surg 2013;28:196–198)

Electroanatomic Mapping Guided Cryoablation of Mahaim Pathways in Children with Limited Fluoroscopy Exposure

The presence of Mahaim accessory pathways (MAP) with anterograde decremental conduction is a disorder that leads to antidromic atrioventricular reentrant tachycardia. There are rare reports of cryoablation use in MAP. This study aims at sharing our experience with using cryoablation to treat MAP in children.

Cryoablation with an 8-mm-Tip Catheter for Right-Sided Accessory Pathways in Children.

Cryoablation is increasingly utilized in children because of its safety profile. Recently, larger catheter tips have been more widely used to improve long‐term success rates. The aim of this study was to assess the safety and efficacy of 8‐mm‐tip catheters for cryoablation of right‐sided accessory pathways (APs) in children.