Authors

• Josip Katić — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0002-4991-1919
• Ante Anić — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0002-6864-3999
• Toni Brešković — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0001-7266-2087
• Zrinka Jurišić — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0001-7583-9036
• Ante Borovina — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0003-2059-4259
• Tanja Kovačević — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0003-4252-9415
• Davor Petrović — Klinički bolnički centar Split, Split, Hrvatska — ORCID: 0000-0003-3064-3835

Abstract

**Introduction:** Percutaneous catheter, mostly radiofrequency (RF), ablation for supraventricular tachycardias is an established way of treating symptomatic patients. Traditionally, essential tool for guiding intracardiac catheter manipulation was X ray fluoroscopy. The risks of exposing patients to ionizing, X ray, radiation are well known, and are of particular concern in pediatric cases or cases involving pregnant women. Recently, with the help of electroanatomical (3D), mapping systems, a possibility to perform these procedures without the use of X ray fluoroscopy, so called «zero fluoro», emerged. (1) **Case report:** This is a case report with an overview of some intraprocedural aspects of «zero fluoro» RF ablation procedure performed at University Hospital Centre Split in 12-year-old with the diagnosis of WPW syndrome (symptomatic SVT episodes with delta wave in native ECG). EP study was performed via right groin venous access and diagnostic catheters inserted in coronary sinus (CS) and right ventricle without the use of X ray. Orthodromic AVRT (atrioventricular reentrant tachycardia) was easily inducible and decision was made to proceed with the RF ablation with the intention of maintain «zero fluoro» principle. Single 40W RF application at proximal CS using contact force catheter and reaching the Lesion Size Index of around 7 abolished permanently accessory pathway conduction. Overall procedure time was 51 minutes, including 20 minutes waiting period for AP recovery. No complications occurred and the ECG the day after the procedure had shown no signs of anterograde AP conduction. **Conclusion**: Zero fluoro approach to RF ablation in patients with WPW syndrome is feasible. It should be preferred approach in vulnerable population such as pediatric cases or cases involving pregnant women.

Keywords

radiofrequency ablation, zero fluoro, WPW, pediatrics

DOI

Literature

1. Jackman WM, Wang XZ, Friday KJ, Roman CA, Moulton KP, Beckman KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med. 1991 Jun 6;324(23):1605–11. https://doi.org/10.1056/NEJM199106063242301