Comparison of radiofrequency catheter ablation procedures in children, adolescents, and adults and the impact of accessory pathway location

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

“…Accessory pathways in AVRT were successfully ablated in 97.8%, which was within the upper range of success rates reported in the literature . Accessory pathways of the right free wall were ablated less successfully compared with the left AP, which is most probably explained by the higher difficulty of finding a stable position for the ablation catheter . Besides, there was a high success rate of 97.2% in children with AVNRT, which also corresponded well to the results reported by several authors (, ).…”

NASPE Expert Consensus Conference: Radiofrequency Catheter Ablation in Children with and without Congenital Heart Disease. Report of the Writing Committee

“…Once patients reach 4 years, age does not appear to be an independent predictor of risk of complication or procedural outcome. 97 Rather, the experience of an institution/individual is the primary correlate of outcome and complication. 71 Third, the long-term efficacy of the procedure is different for the various arrhythmias (i.e., whereas long-term efficacy for accessory AV connections exceeds 90%) the efficacy for intraatrial reentrant tachycardia is only 50%.…”

Effects of Ventilation and Catheter Position on Catheter Movement on the Tricuspid Annulus during Ablation in Children

“…There are a plethora of factors that can lead to failure during the ablation of an accessory pathway or AVNRT in children, including proximity to the compact AV node and risk of AV nodal injury, poor tissue contact, insufficient lesion formation, anatomical abnormalities, epicardial location of a pathway, and poor catheter stability. Historically, the success rates in the RL region are lower than other locations and our findings point to one possible explanation . Lower success rates in the RL region may be due, in part, to a higher magnitude of catheter movement, and therefore, less precision, accuracy, and consistency with the ablation lesion application.…”

“…Success rates at different locations on the tricuspid annulus are also different. The right lateral (RL) region, for example, has historically been a more challenging position to ablate an accessory pathway, with a steeper learning curve, longer procedural times, and lower success rates . Reasons for the discrepancy in success rates between the RL region and the right posteroseptal (RPS) region have been postulated to include increased difficulty in accurate pathway localization, poor catheter tissue contact, and poor catheter stability.…”