Roses-Noguer Ferran, Hebe Joachim
Paediatric Cardiology Department, Vall Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
Royal Brompton Hospital, Guy's and St Thomas Foundation Trust, London, UK.
Herzschrittmacherther Elektrophysiol. 2025 Sep 15. doi: 10.1007/s00399-025-01102-9.
Paediatric catheter ablation procedures have traditionally relied heavily on fluoroscopic guidance, exposing children to ionizing radiation and the associated long-term cancer risks ranging from 0.4 to 6.0% of total lifetime cancer risk. This necessitates technological innovations to minimize radiation dependency while maintaining therapeutic effectiveness.
To review current state-of-the-art technologies and emerging innovations in paediatric catheter ablation.
This review examines advanced three-dimensional (3D) mapping algorithms, including low voltage bridge mapping, late annotation electrograms, open window mapping, and omnipolar technology for substrate characterization. Intracardiac echocardiography and digital twin frameworks utilizing cardiac magnetic resonance imaging, computed tomography, and electrocardiogram data for personalized procedural planning are also analyzed.
The implementation of advanced 3D mapping systems demonstrates a marked reduction in radiation exposure while optimizing procedural outcomes across structurally normal and complex congenital heart disease patients. Intracardiac echocardiography provides high-resolution real-time imaging, eliminating fluoroscopic dependence and enabling dynamic clinical decision-making during complex procedures. Focal pulsed field ablation may have a role in paediatric ablations, as it potentially reduces the risk of damaging the conduction tissue and other nearby structures.
The integration of advanced imaging technologies represents transformative progress in paediatric electrophysiology, enabling safer, more precise interventions with significantly reduced radiation exposure. These innovations establish new paradigms for personalized paediatric cardiac care, promising improved long-term outcomes for vulnerable populations requiring catheter ablation procedures.
传统上，儿科导管消融手术严重依赖荧光透视引导，使儿童暴露于电离辐射以及相关的长期癌症风险中，这种风险占终身癌症总风险的0.4%至6.0%。这就需要技术创新，以在保持治疗效果的同时尽量减少对辐射的依赖。
回顾儿科导管消融的当前先进技术和新兴创新。
本综述研究了先进的三维（3D）标测算法，包括低电压桥标测、晚期注释心电图、开窗标测和用于基质表征的全极技术。还分析了利用心脏磁共振成像、计算机断层扫描和心电图数据进行个性化手术规划的心腔内超声心动图和数字孪生框架。
先进3D标测系统的应用显示，在优化结构正常和复杂先天性心脏病患者的手术结果的同时，辐射暴露显著减少。心腔内超声心动图提供高分辨率实时成像，消除了对荧光透视的依赖，并在复杂手术过程中实现动态临床决策。局灶性脉冲场消融可能在儿科消融中发挥作用，因为它有可能降低损伤传导组织和其他附近结构的风险。
先进成像技术的整合代表了儿科电生理学的变革性进展，能够实现更安全、更精确的干预，同时显著减少辐射暴露。这些创新为个性化儿科心脏护理建立了新范式，有望改善需要导管消融手术的弱势群体的长期治疗效果。
