Catheter ablation of accessory pathways in children

Abstract

The efficacy and safety of catheter ablation of accessory pathways (AP) was studied in 79 children (age, 4-16 years), using DC shocks (n = 25) or radiofrequency energy (n = 54). All patients had documented arrhythmias including ventricular fibrillation in four. Organic heart disease was present in four patients. AP locations were left lateral (n = 36), posteroseptal (n = 36), right lateral (n = 8), Mahaim fibres (n = 2) and right anteroseptal (n = 6). Seven patients had multiple AP. One patient had a preexcitation which appeared secondary to an atrio-infundibular connection (Fontan procedure). The ablation site of concealed or overt AP was identified by retrograde or anterograde conduction mapping, respectively. A mean of 2.6 +/- 1 cathodal shocks (80-160 J) was delivered to 25 patients over 29 sessions, resulting in initial AP ablation in all. Fulguration was uncomplicated in all except in one patient (4%) who developed a secondary complete AV block post-ablation. During a follow-up period of 30-69 months, intermittent preexcitation recurred in two asymptomatic patients, but no significant tachycardia was inducible at late electrophysiological study, including under isoproterenol infusion. Radiofrequency energy was applied to 54 patients during 62 sessions, using 20-40 watts for 30-60 s. AP ablation was initially achieved in all patients using a median of three impulses, without significant immediate side-effects. Two patients (4%) developed a short episode of blurred vision possibly due to a microembolism. After discharge, the follow-up period was 10 +/- 5 months (range 1 to 24). All patients but one (98%) were asymptomatic without any drug therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents

“…Overall, there was a recurrence rate of 9.1%, which is within the range of 6 to 12% given in the literature . In accordance with the literature, there was a very low recurrence rate of 2.9% in patients with AVNRT , but higher recurrence rates for patients with AVRT or VT .…”

Supraventricular Tachycardia in Infants, Children and Adolescents

“…[26][27][28][29] In young patients with atrial ectopic tachycardia and the permanent form of junctional reciprocating tachycardia, drug therapy may work in a considerable proportion of patients and some of these patients may 'outgrow' the dysrhythmia. [31][32][33][34][35][36][37][38] Despite the clear advantages of radiofrequency catheter ablation, the procedure should be performed in young patients only with unquestionable indication. [5,30] The efficacy and tolerability of radiofrequency catheter ablation in young patients may be demonstrated by the data for patients ≤17 years of age treated at our institution.…”

Supraventrikuläre Tachykardien bei Säuglingen, Kindern und Jugendlichen: Diagnostik – Medikamentöse und interventionelle Therapie

“…Die Effizienz und Sicherheit der Katheterablation per Hochfrequenzstromapplikation bei jungen Patienten sind von einer beträchtlichen Anzahl von Arbeitsgruppen sowie durch die Ergebnisse des Registry der American Pediatric Electrophysiology Society (7,17,23,42,44,45,47,57) inzwischen eindrucksvoll belegt worden.…”