J Korean Med Sci.  2005 Oct;20(5):740-746. 10.3346/jkms.2005.20.5.740.

Pediatric Radiofrequency Catheter Ablation: Results of Initial 100 Consecutive Cases Including Congenital Heart Anomalies

• Bae EJ
• Ban JE
• Lee JA
• Jin SM
• Noh CI
• Choi JY
• Yun YS

• KMID: 1781754
• DOI: http://doi.org/10.3346/jkms.2005.20.5.740

Abstract

Radiofrequency catheter ablation (RFCA) has recently become a management option for pediatric tachycardia. We reviewed the records of a total of 100 patients (aged 10 months to 19 yr) who had undergone RFCA, from March 2000 to June 2004. Types of arrhythmia (age, acute success rate) were as follows: atrioventricular reentrant tachycardia (AVRT, 9.0+/-3.7 yr, 66/67), atrioventricular nodal reentrant tachycardia (AVNRT, 13+/-2.5 yr, 16/16), ectopic atrial tachycardia (6.4+/-3.3 yr, 5/5), junctional ectopic tachycardia (10 month, 1/1), ventricular tachycardia (12+/-4.9 yr, 6/6), postsurgical intraatrial reentrant tachycardia (15.6+/-4.1 yr, 2/3), twin node tachycardia (4 yr, 0/1), and His bundle ablation (9 yr, 1/1). The age of AVNRT was older than that of AVRT (p=0.002). Associated cardiac disease was detected in 17 patients, including 6 univentricular patients, and 3 Ebstein's anomaly patients. RFCA for multiple accessory pathways required longer fluoroscopic times than did the single accessory pathway (53.9+/-4.8 vs. 36.2+/-24.1 min; p=0.03), and was associated with a higher recurrence rate (3/9 vs. 3/53; p=0.03). Regardless of the presence or absence of cardiac diseases, the overall acute success rate was 97% without major complications, the recurrence rate was 8.2%, and the final success rate was 97%. This experience confirmed the efficacy and safety of RFCA in the management of tachycardia in children.

Keyword

Tachycardia; Catheter Ablation; Heart Defects, Congentital

MeSH Terms

Catheter Ablation/*statistics and numerical data
Child
Comorbidity
Female
Heart Defects, Congenital/*epidemiology/*surgery
Humans
Korea/epidemiology
Male
Pilot Projects
Postoperative Complications/epidemiology
Prevalence
Retrospective Studies
Risk Assessment/*methods
Risk Factors
Tachycardia/*epidemiology/*surgery
Treatment Outcome

Figure

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  Fig. 1 This bar graph shows the age distributions of the patients undergoing radiofrequency catheter ablation. The age of the total of 100 patients ranged from 10 months to 19 yr, with a mean of 10.2±4.1 yr. The failed or recurred cases, as well as the major congenital heart disease patients were distributed nonspecifically throughout the entire age range.

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  Fig. 2 This diagram depicts the accessory pathway locations of 67 patients with atrioventricular reentrant tachycardia. The multiple pathways were marked separately in this figure. The left lateral atrioventricular groove was the most frequent location of the accessory pathway. TV, tricuspid valve; MV, mitral valve.

Reference

1. Dick M 2nd, O'Connor BK, Serwer GA, LeRoy S, Armstrong B. Use of radiofrequency current to ablate accessory connections in children. Circulation. 1991. 84:2318–2324.

2. Kugler JD, Danford DA, Deal BJ, Gillette PC, Perry JC, Silka MJ, Van Hare GF, Walsh EP. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. N Engl J Med. 1994. 330:1481–1487.

3. Van Hare GF, Witherell CL, Lesh MD. Follow-up of radiofrequency catheter ablation in children: results in 100 consecutive patients. J Am Coll Cardiol. 1994. 23:1651–1659.

4. Kugler JD, Danford DA, Houston K, Felix G. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Am J Cardiol. 1997. 80:1438–1443.

5. Danford DA, Kugler JD, Deal B, Case C, Friedman RA, Saul JP, Silka MJ, Van Hare GF. Participating members of the Pediatric Electrophysiology Society. The learning curve for radiofrequency ablation of tachyarrhythmias in pediatric patients\. Am J Cardiol. 1995. 75:587–590.

6. Paul T, Bertram H, Bokenkamp R, Hausdorf G. Supraventricular tachycardia in infants, children and adolescents: diagnosis, and pharmacological and interventional therapy. Paediatr Drugs. 2000. 2:171–181.

7. Kugler JD, Danford DA, Houston KA, Felix G. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol. 2002. 13:336–341.

8. Ko JK, Park IS, Kim YH, Hong CY, Kim JJ. Early results of radiofrequency catheter ablation of supraventricular tachycardia in children. J Korean Pediatr Soc. 1997. 40:1258–1264.

9. Lee SJ, Jung MJ, Kim SH, Schueller WC, Kim GH, Lee HS. Treatment of tachycardia by radiofrequency catheter ablation in children and adolescents. J Korean Pediatr Soc. 2000. 43:210–215.

10. Friedman RA, Walsh EP, Silka MJ, Calkins H, Stevenson WG, Rhodes LA, Deal BJ, Wolff GS, Demaso DR, Hanisch D, Van Hare GF. North American Society of Pacing and Electrophysiology. NASPE Expert Consensus Conference: Radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. Pacing Clin Electrophysiol. 2002. 25:1000–1017.

11. Deal BJ, Keane JF, Gillette PC, Garson A Jr. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol. 1985. 5:130–135.

12. Ko JK, Deal BJ, Strasburger JF, Benson DW Jr. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol. 1992. 69:1028–1032.

13. Perry JC, Garson A Jr. Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol. 1990. 16:1215–1220.

14. Van Hare GF, Phoon CK, Munkenbeck F, Patel CR, Fink DL, Silverman NH. Electrophysiologic study and radiofrequency ablation in patients with intracardiac tumors and accessory pathways: is the tumor the pathway? J Cardiovasc Electrophysiol. 1996. 7:1204–1210.

15. Van Hare GF, Lesh MD, Stanger P. Radiofrequency catheter ablation of supraventricular arrhythmias in patients with congenital heart disease: results and technical considerations. J Am Coll Cardiol. 1993. 22:883–890.

16. Levine JC, Walsh EP, Saul JP. Radiofrequency ablation of accessory pathways associated with congenital heart disease including heterotaxy syndrome. Am J Cardiol. 1993. 72:689–693.

17. Triedman JK, Bergau DM, Saul JP, Epstein MR, Walsh EP. Efficacy of radiofrequency ablation for control of intraatrial reentrant tachycardia in patients with congenital heart disease. J Am Coll Cardiol. 1997. 30:1032–1038.

18. Van Hare GF, Lesh MD, Ross BA, Perry JC, Dorostkar PC. Mapping and radiofrequency ablation of intraatrial reentrant tachycardia after the Senning or Mustard procedure for transposition ofthe great arteries. Am J Cardiol. 1996. 77:985–991.

19. Triedman JK, Alexander ME, Berul CI, Bevilacqua LM, Walsh EP. Electroanatomic mapping of entrained and exit zones in patients with repaired congenital heart disease and intra-atrial reentrant tachycardia. Circulation. 2001. 103:2060–2065.

20. Bae EJ, Noh CI, Choi JY, Yun YS, Kim WH, Lee JR, Kim YJ. Twin AV node and induced supraventricular tachycardia in Fontan palliation patients. Pacing Clin Electrophysiol. 2005. 28:126–134.

21. Epstein MR, Saul JP, Weindling SN, Triedman JK, Walsh EP. Atrioventricular reciprocating tachycardia involving twin atrioventricular nodes in patients with complex congenital heart disease. J Cardiovasc Electrophysiol. 2001. 12:671–679.