Korean Circ J.  2012 Nov;42(11):735-740. 10.4070/kcj.2012.42.11.735.

Pediatric Tachyarrhythmia and Radiofrequency Catheter Ablation: Results From 1993 to 2011

• Kim YH
• Park HS
• Hyun MC
• Kim YN

• KMID: 2224972
• DOI: http://doi.org/10.4070/kcj.2012.42.11.735

Abstract

BACKGROUND AND OBJECTIVES
We performed a retrospective study to elucidate the frequency of tachycardia mechanisms and the characteristics of accessory pathways (APs), confirmed by radiofrequency catheter ablation (RFCA) in pediatric tachycardia. In addition, we analyzed the efficacy and safety of pediatric RFCA.
SUBJECTS AND METHODS
The authors retrospectively reviewed the records of a total of 260 patients (aged 2 to 18 years) who had undergone RFCA between August 1993 and July 2011 at two medical centers in Daegu.
RESULTS
Two hundred and sixty patients underwent 272 RFCAs at less than 18 years of age. Of these 260 patients, 9 patients (3%) were younger than 6 years, and 175 patients (67%) were older than 12 years. The tachycardia mechanisms observed were atrioventricular reentry tachycardia (AVRT) in 175 patients (65%), atrioventricular nodal reentry tachycardia (AVNRT) in 83 patients (30%), ventricular tachycardia in 12 patients (4%), and atrial tachycardia in 2 patients (0.7%). Among the patients with AVRT, there were 94 concealed APs and 81 manifest APs. Left-side APs were more common in concealed APs than in manifest APs (72/94, 77% vs. 33/81, 41%, p<0.001). Sixty-six percent (55/83) of AVNRT cases were located at the M1 and/or M2 sites. Four patients had multiple tachycardia mechanisms (AVNRT+AVRT) and 9 patients had multiple APs. The recurrence rate was 5% (13/272). Of these recurrent cases, 12 patients had AVRT. The overall success rate was 95%.
CONCLUSION
Pediatric RFCA provides a good success rate and an acceptable recurrence. In addition, we suggest that the APs location may be associated with concealed or manifest property of APs.

Keyword

Pediatrics; Tachycardia, supraventricular; Catheter ablation

MeSH Terms

Catheter Ablation
Catheters
Humans
Pediatrics
Recurrence
Retrospective Studies
Tachycardia
Tachycardia, Atrioventricular Nodal Reentry
Tachycardia, Supraventricular
Tachycardia, Ventricular

Figure

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  Fig. 1 The classification according to tachycardia mechanism. The most common tachycardia mechanism was AVRT. AVRT occurred more frequently than AVNRT (65% vs. 30%, p=0.0001). AVRT: atrioventricular reentry tachycardia, AVNRT: atrioventricular nodal reentry tachycardia, VT: ventricular tachycardia, AT: atrial tachycardia, AP: accessory pathway.

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  Fig. 2 The locations of APs in atrioventricular reentry tachycardia induced by concealed APs. In 94 patients, 79% of APs (74/94) was located on the left. The most common site for left-side APs was the left lateral wall (43/74, 58%). APs: accessory pathways, TA: tricuspid annulus, MA: mitral annulus.

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  Fig. 3 locations of APs in atrioventricular reentry tachycardia with manifest APs. In 81 patients, 60% of APs (49/81) was located on the right. The three most common sites of AP were the left lateral wall (19/81, 23%), the right posteroseptal wall (12/81, 15%), and the right lateral wall (10/81, 12%). APs: accessory pathways, TA: tricuspid annulus, MA: mitral annulus.

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  Fig. 4 Age related changes in tachycardia mechanisms. The most frequent tachycardia mechanism was AVRT. Although AVNRT occurred more common in older age than in younger age, there was no significant difference between tachycardia mechanism and age. AVRT: atrioventricular reentry tachycardia, AVNRT: atrioventricular nodal reentry tachycardia, VT: ventricular tachycardia, AT: atrial tachycardia.

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