New technologies for the transcatheter treatment of arrhythmias

Abstract: Indication for transcatheter radiofrequency ablation in children with supraventricular tachycardia is still controversial. In the last ten years, these indications underwent some changes, due to the technique development and the results improvement. Important factors should be taken into account when deciding about ablation on a child affected by tachyarrhythmia: 1) the arrhythmia grade of malignancy; 2) its natural history; 3) procedure success rate; 4) possibility and frequency of early or late complications. At the moment, there is a remarkable success for ablation of accessory pathways (93%) as well as for the other types of tachycardia (78-98%). In future, reducing the risks of transcatheter ablation and making it more practicable on younger patients should be the electrophysiologist pediatrician's effort. Cryoablation has eliminated the risk of atrioventricular iatrogenic block during ablation of parahissian pathways and of "slow" atrioventricular nodal pathway. New systems of non fluoroscopic tridimensional ablation already have produced some important innovations in terms of vascular accesses minimization and fluoroscopy time as in terms of increasing the percentage of success rate during ablation of atrial tachycardias with or without congenital heart disease.