Contact force ablation of accessory pathways in pediatric patients.

INTRODUCTION: Contact force (CF) catheters provide feedback confirming adequate tissue contact for optimal lesion size and minimal complications. CF ablation catheters have resulted in decreased procedure times and improved outcomes for ablation of atrial fibrillation in adults. There is limited data evaluating CF use for accessory pathway (AP) ablation or in pediatric patients. The aim of our study was to compare a cohort who underwent AP ablation with a CF catheter to historical controls, evaluating for differences in procedure times, number of lesions, and outcomes. METHODS: A retrospective chart review of CF ablation cases at Children's Wisconsin performed between June 2015 to April 2018 was compared to a historical control cohort of traditional radiofrequency (RF) ablations between June 2012 and June 2015. 43 patients with APs underwent 49 CF ablation procedures (18 males, 13.6 ± 3 years old) and a control cohort consisted of 77 procedures in 69 patients (38 males, 12.4 ± 4 years). RESULTS: The groups did not differ significantly on procedure time (CF 2.01 ± 0.48 h, control 1.53 ± 0.48 h, p = .37), or total lesions administered (CF and control 7 ± 6 lesions, p = .89). CF cases showed a trend toward improvement in acute success (98% CF, 90% controls, p = .15) though with increased recurrence compared to controls (13% CF, 4.3% controls, p = .16), neither being statistically significant. CONCLUSION: Our study suggests that ablation outcomes using CF are comparable to traditional RF ablation in pediatric patients with APs.

Expression pattern of Nav2 in the murine CNS with development.

Neuron navigator 2 (NAV2, RAINB1, POMFIL2, HELAD1, unc53H2) is essential for nervous system development. In the present study the spatial distribution of Nav2 transcript in mouse CNS during embryonic, postnatal and adult life is examined. Because multiple NAV2 proteins are predicted based on alternate promoter usage and RNA splicing, in situ hybridization was performed using probes designed to the 5' and 3' ends of the Nav2 transcript, and PCR products using primer sets spanning the length of the mRNA were also examined by real time PCR (qPCR). These studies support full-length Nav2 transcript as the predominant form in the wild-type mouse CNS. The developing cortex, hippocampus, thalamus, olfactory bulb, and granule cells (GC) within the cerebellum show the highest expression, with a similar staining pattern using either the 5'Nav2 or 3'Nav2 probe. Nav2 is expressed in GC precursors migrating over the cerebellar primordium as well as in the postmitotic premigratory cells of the external granule cell layer (EGL). It is expressed in the cornu ammonis (CA) and dentate gyrus (DG) throughout hippocampal development. In situ hybridization was combined with immunohistochemistry for Ki67, CTIP2 and Nissl staining to follow Nav2 transcript location during cortical development, where it is observed in neuroepithelial cells exiting the germinal compartments, as well as later in the cortical plate (CP) and developing cortical layers. The highest levels of Nav2 in all brain regions studied are observed in late gestation and early postnatal life which coincides with times when neurons are migrating and differentiating. A hypomorphic mouse that lacks the full-length transcript but expresses shorter transcript shows little staining in the CNS with either probe set except at the base of the cerebellum, where a shorter Nav2 transcript is detected. Using dual fluorescent probe in situ hybridization studies, these cells are identified as oligodendrocytes and are detected using both Olig1 and the 3'Nav2 probe. The identification of full-length Nav2 as the primary transcript in numerous brain regions suggests NAV2 could play a role in CNS development beyond that of its well-established role in the cerebellum.