Long-Term Follow-Up After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children

Abstract

Background-Catheter ablation of the slow conducting pathway (SP) is treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT). Although there are abundant data on AVNRT ablation in adult patients, little is known about the long-term results ≥3 years after AVNRT ablation in pediatric patients. Methods and Results-Follow-up data from 241 patients aged ≤18 years who had undergone successful AVNRT ablation were analyzed. Median age at ablation had been 12.5 years, and median follow-up was 5.9 years. Radiofrequency current had been used in 168 patients (70%), whereas cryoenergy had been used in 73 patients (30%). Procedural end point of AVNRT ablation had been either SP ablation (no residual dual atrioventricular nodal physiology) or SP modulation (residual SP conduction allowing for a maximum of one atrial echo beat). After the initial AVNRT ablation, calculated freedom from AVNRT was 96% at 1 year, 94% at 3 years, 93% at 5 years, and 89% at 8 years. Age, sex, body weight, the choice of ablation energy, and the procedural end point of AVNRT ablation did not impact freedom from AVNRT. Six of 22 AVNRT recurrences (27%) occurred ≥5 years after ablation. No late complications including atrioventricular block were noted. Conclusions-Cumulatively, catheter ablation of AVNRT continued to be effective in >90% of our pediatric patients during the long-term course. A significant part of recurrences occurred >5 years post ablation. Body weight, energy source, and the end point of ablation had no impact on long-term results. No adverse sequelae were noted. (Circ Arrhythm Electrophysiol. 2016;9:e004264.

Look and you shall find: Perils along the road after slow pathway ablation for AV nodal reentry tachycardia

“…Invasive and noninvasive studies revealed sinus tachycardia (4.7%), recurrence of AVNRT (5.2%), and other atrial arrhythmias (6.1%) responsible for recurrent palpitations in a large cohort of 835 adult patients successively ablated for AVNRT. Recurrence of AVNRT has been reported to be higher in younger subjects, up to 11% as reported by Backhoff et al . AVNRT may coexist with other arrhythmias.…”

“…The incidence of complete AV block during AVNRT ablation has decreased since the procedure's inception, and is now less than 0.5% . However, late AV block has been documented in the postablation period . Autonomic dysfunction resulting in inappropriate sinus tachycardia has been observed, and Kanjwal et al.…”

“…6,10 However, late AV block has been documented in the postablation period. 8,11,12 Autonomic dysfunction resulting in inappropriate sinus tachycardia has been observed, 12 15 is the lack of a standardized protocol for electrocardiographic monitoring postablation, suggesting the data reported are only the tip of the iceberg. Noted in the authors' review of the literature were three pediatric cases, raising the issue of whether this arrhythmia might be more common in children.…”

Tachycardia cycle and atrioventricular nodal conduction properties in children with supraventricular tachycardia

“…Finally, the reader suggested analysis of the AH interval during AVNRT based on age, as other data in the literature have suggested that the AH interval could be associated with the physical length of the slow pathway . Others have also suggested that the length of the slow pathway is critical to the development of AVNRT, as perhaps there is a critical “length” required for the development of tachycardia, and this length factor may explain why AVNRT is rarer in young children . As suggested by the reader, we compared the AH intervals during AVNRT in children under 10 years of age to those over 10.…”

Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction

“…20,25,29,30 However, in those aged ≤18 years, recurrence may occur up to 5 years postablation. 31 Success rates are lower (82 %) and the risk of heart block higher (14 %) in patients with complex congenital heart disease. 32 Advanced age is not a contraindication for slow pathway ablation.…”