[Transcatheter cryoablation in children: state of the art].

A new transcatheter ablation method has recently made its appearance in leading electrophysiology laboratories: cryoablation. In contrast with radiofrequency, this method produces a permanent lesion due to cell necrosis, caused by application of very low temperature chilling to the tip of special ablation catheters placed against the area of the heart causing arrhythmia. The benefit of this system over radiofrequency ablation is its ability to find the most suitable site for ablation through transitory electrical paralysis of the heart tissue in contact with the catheter tip, chilled to -30 degrees C (cryomapping). If the site is suitable, the tissue causing the arrhythmia loses its excitability. Moreover, the stability of the catheter tip, which adheres to the myocardium, enables arrhythmia inducibility through programmed atrial stimulation to be assessed without dislodging the catheter. A permanent lesion is created only subsequently, with further chilling to even lower temperatures (cryoablation). In the last 3 years the success rate of cryoablation in pediatric patients has increased and long-term complications have not been described yet. We therefore consider that cryoablation should be considered the treatment of choice for atrioventricular nodal reentrant tachycardia and parahissian, anteroseptal and right midseptal accessory pathway atrioventricular reentrant tachycardia in school-age children. In fact cryoablation is thus "made to measure" for pediatric patients because if an atrioventricular block is observed, stopping the procedure is quickly followed by the restoration of normal atrioventricular conduction.