Radiofrequency Catheter Ablation in Infants ≤18 Months Old

Abstract

Participating Members of the Pediatric Catheter Ablation Registry* Background-The objective of this study was to determine the indications, the safety, and the efficacy of pediatric radiofrequency catheter ablation (RFCA) in infants. Methods and Results-Data from the pediatric RFCA registry were reviewed. Between August 1989 and January 1999, 137 infants, defined by age 0 to 1.5 years (median 0.7 years; weight 1.9 to 14.8 kg, median 10 kg), underwent 152 procedures in 27 of 49 registry centers (55%), compared with 5960 noninfants undergoing 6610 procedures during a comparable period. Structural heart disease was present in 36% of infants, compared with 11.2% of noninfants (PϽ0.0001). RFCA in infants was performed more commonly for drug resistance or life-threatening arrhythmias than in noninfants. No differences were found between infants and noninfants in success for all tachycardia substrates (87.6% versus 90.6%, Pϭ0.11), for single accessory pathways (94.5% versus 91.5%, Pϭ0.4), or for total (7.8% versus 7.4%, Pϭ1) and major (4.6% versus 2.9%, Pϭ0.17) complications. Neither success for infants with a single accessory pathway nor complications for the entire infant group were related to weight, age, center size, or the presence of structural heart disease. Centers that performed infant procedures, however, enrolled more patients overall in the registry than those that did not perform infant procedures, and successful procedures in infants were performed by more experienced physicians than failed procedures. Conclusions-Compared with noninfants, RFCA in infants is usually performed for drug resistance or life-threatening arrhythmias, often in the presence of structural heart disease. The data support the use of RFCA by experienced physicians in selected infants. (Circulation. 2001;104:2803-2808.)

Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Infants and Toddlers

“…18 However, several recent studies have shown promising results of RFCA for SVT in young children. 11,14 In the present study, the proportion of patients with AT (18.5%), congenital heart disease and multiple mechanisms of SVT (11.1%), which may increase the difficulties of RFCA, was relatively high. 19,20 Nonetheless, the acute success rate (92.6%), major complication rate (3.7%), and recurrence rate (13%) were all comparable to those in our previous report on the whole pediatric population and in other pediatric reports.…”

“…19,20 Nonetheless, the acute success rate (92.6%), major complication rate (3.7%), and recurrence rate (13%) were all comparable to those in our previous report on the whole pediatric population and in other pediatric reports. 1,3,[11][12][13][14]21 The presence of congenital heart disease was not associated with worse outcomes, but this should be interpreted with caution. Most of our patients with congenital heart disease requiring RFCA at such a young age had congenital heart disease other than Ebstein's anomaly, which is notoriously associated with lower success rates and higher recurrence rates.…”

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

“…należy unikać dożylnego podawania werapamilu, ponieważ lek ten może być przyczyną ostrej dekompensacji hemodynamicznej [476]. U małych dzieci powikłania ablacji przezcewnikowej wydają się częstsze, a ponadto istnieją obawy o konsekwencje w fazie dalszego wzrostu po wywołaniu uszkodzeń termoablacyjnych lub krwioablacyjnych w mięśniu sercowym [475,[485][486][487]. Idiopatyczny VT i złożone PVC u dzieci zwykle ustępują samoistnie w ciągu miesięcy do lat [471].…”

Radiofrequency catheter ablation in infants and children

“…In a retrospective analysis comparing RFCA in infants <18 months to older children no difference was found, either for success rate, or incidence of major complications. (16) Secondary analysis of patients weighing <15kg, including those older than 18 months, showed an increase in major, but not overall, complication rate. The presence of WPW syndrome associated with syncope when there is a short R-R interval during atrial fi brillation (preexcited R-R interval 250ms) or the anterograde effective refractory period of the AP measured during programmed electrical stimulation is <250ms.…”