What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous pediatric ablation registries

BACKGROUND Since the onset of pediatric catheter ablation, the pediatric electrophysiology community has reported outcomes via various registries (PAPCA [Prospective Assessment After Pediatric Cardiac Ablation], PCAR [Pediatric Catheter Ablation Registry]). Most recently, a modern era pediatric and congenital ablation registry (MAP-IT [Multicenter Pediatric and Congenital EP Quality Initiative]) was developed for eventual incorporation into the National Cardiovascular Data Registry (NCDR) IMPACT (Improving Pediatric and Adult Congenital Treatment) registry. OBJECTIVE The purpose of this study was to describe initial findings from the MAP-IT pilot registry and to compare these findings to earlier registries. METHODS Before entering the NCDR IMPACT registry, MAP-IT was active at 12 centers (11 in the United States) between October 2014 and April 2016. All electrophysiological studies for patients younger than 21 years and for patients of all ages with structural congenital heart disease were included. We compared the acute success, fluoroscopy and proceduraltimes, and frequency of complications between MAP-IT and the earlier registries. RESULTS Acute success rates have improved from the initial PCAR registry for both accessory and slow pathway substrates. Both fluoroscopy and procedural times have significantly decreased across the time periods (fluoroscopy time 47.6 +/- 40 minutes to 7.0 +/- 9.2 minutes; P <.001; procedural time 257 +/- 157 minutes to 166 +/- 84 minutes; P <.001). CONCLUSION Acute success rates and fluoroscopy and procedural times in pediatric ablation all have improved over the last 25 years.