Limitations and future studies
Our study experienced limited power as a single institution retrospective study with only 49 CF cases and 77 controls. As more children undergo cardiac ablation with CF technology, larger cohorts for both control and CF could elucidate patterns that were not statistically significant in this small initial study. In addition, it would prove useful to carry out a prospective multi-center study using a standard CF ablation protocol. It has been shown with many new medical technologies, especially technically intricate catheter ablation, that procedure times significantly shorten as a function of experience.13By collecting data at multiple institutions, future research would include more operators who may be more or less familiar with CF technology. Widening this scope will allow a better analysis of CF outcomes without interference of individual user variability.
Many AP locations were included in the present study, and we did not find significant differences in procedure details or long-term outcomes. Although our data is not significant, it is not unlike early studies of CF in adult patients with results varying depending on the arrhythmia specifics and study parameters. This may represent an era effect as operators are becoming more familiar with the utility and limitations of new technology. In future studies, differences between pathway locations and details such as transseptal or retrograde approach may prove to be important factors in determining differences in CF and traditional RF ablation. Overall, further investigation with higher power studies is necessary to show trends that may exist in the use of CF in pediatric AP ablation.