Management of the Child with Wolff‐Parkinson‐White Syndrome and Supraventricular Tachycardia:

Abstract

In the next decade, "better" management will be defined by cost effectiveness including morbidity, mortality, and cost. We used a cost-effectiveness model for children with Wolff-Parkinson-White syndrome (WPW) and supraventricular tachycardia (SVT) comparing medical, surgical, and catheter ablative treatment between age 5 years (estimated average age at first recurrence after infancy) and age 21. Charges were quantitated from actual hospital bills; mortality was estimated from the literature; morbidity was assessed by estimating the number of hours in SVT, hours in clinic, hours in routine hospital bed, and hours in hospital intensive care; and the hours were then multiplied by a severity factor, normalized to 1.0 for 1 hour of SVT (0.5 for 1 hour in clinic, 0.75 for routine hospital, and 2.0 for intensive care). Overall charges (5 to 21 years old) for catheter ablation ($17,236) were 39% of surgical management and 57% of medical management; estimated mortality for catheter ablation (5 to 21 years old including failures that reverted to medical management) was 0.15%, which was 10% of medical management and 28% of surgical management; morbidity for catheter ablation was 27.6 units, which was 32% of medical management and 36% of surgical management. Sensitivity analysis demonstrated that the catheter ablation strategy remained preferable throughout the range of plausible values of cost, mortality, and morbidity (including a repeat procedure for initial failures). Therefore, catheter ablation has lower cost, mortality, and morbidity than either medical management or surgery and is the treatment of choice for the child 5 years of age or older with WPW and SVT. This type of analysis can be used for other forms of chronic disease in children.

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

“…283,284 Catheter ablation of an atriofascicular (Mahaim) pathway is successful in preventing reentrant tachycardia in approximately 70% to 100% of patients. 285 Flecainide and propafenone are beneficial for the treatment of AVRT by directly slowing or blocking conduction over the pathway. These drugs are effective in approximately 85% to 90% of patients, with 30% reporting an absence of tachycardia.…”

Catheter ablation in paediatric arrhythmias

“…Garson and Kanter recently provided a cost effectiveness model for management of tachycardia 8. They compared the cost, morbidity, mortality, and efficacy of drug treatment, surgery, and radiofrequency ablation for a 5 year old child with symptomatic tachycardia associated with Wolff-Parkinson-White syndrome.…”

Ebstein’s malformation

“…Cost/cost effectiveness Garson and Kanter [22] reported that in patients 5 to 21 years of age with Wolff-Parkinson-White syndrome and supraventricular tachycardia, the cost of catheter ablation was 39% of surgical management and 57% of medical management, with less overall morbidity and mortality.…”