Percutaneous radiofrequency catheter ablation for supraventricular arrhythmias in children

Department of Pediatrics, University of California San Francisco School of Medicine.

Nineteen procedures were performed in 17 children, aged 10 months to 17 years, using catheter radiofrequency applications for the management of malignant or drug-resistant supraventricular tachyarrhythmias. Diagnoses were junctional ectopic tachycardia in 1 patient, atrioventricular (AV) node reentrant tachycardia in 4 and accessory pathway-mediated tachycardia in 12. Accessory pathway locations were left lateral (n = 4), posteroseptal (n = 3), left posterior (n = 2), right posterolateral (n = 1), right posterior paraseptal (n = 1), right intermediate septal (n = 1) and right anterior (n = 1). Ablation of accessory pathways was performed using 20 to 40 W of energy. The catheter was passed retrograde to the left ventricle in patients with a left-sided pathway and anterograde to the right atrium in those with a right-sided or posteroseptal pathway. In the 12 patients with an accessory pathway, radiofrequency applications were successful in 11 pathways and failed in 2. There were no recurrences of accessory pathway-mediated tachycardia. Atrioventricular node reentrant tachycardia was treated by AV node modification using 15 W of energy applied until first degree AV block occurred. After radiofrequency catheter ablation, there was a prolonged AH interval, tachycardia was not inducible and tachycardia recurred in one patient. For the patient with junctional ectopic tachycardia, 15 to 18 W of energy was delivered at the site of the maximal His bundle electrogram until sinus rhythm and normal AV conduction appeared. After a recurrence, a second procedure abolished tachycardia and AV conduction. In summary, radiofrequency catheter ablation was initially successful in 17 of 19 procedures and ultimately curative in 14 (82%) of 17 patients with no serious complications. Radiofrequency catheter ablation appears to be a safe and effective method for the management of supraventricular tachyarrhythmias in children.

This article has been cited by other articles:

				J. C. Salerno and S. P. Seslar Supraventricular Tachycardia Arch Pediatr Adolesc Med, March 1, 2009; 163(3): 268 - 274. [Abstract] [Full Text] [PDF]

				A. Miyazaki, A. D. Blaufox, D. L. Fairbrother, and J. P. Saul Cryo-ablation for septal tachycardia substrates in pediatric patients: Mid-term results J. Am. Coll. Cardiol., February 15, 2005; 45(4): 581 - 588. [Abstract] [Full Text] [PDF]

				A. D. Blaufox, G. L. Felix, and J. P. Saul Radiofrequency Catheter Ablation in Infants <=18 Months Old: When Is It Done and How Do They Fare?: Short-Term Data From the Pediatric Ablation Registry Circulation, December 4, 2001; 104(23): 2803 - 2808. [Abstract] [Full Text] [PDF]

				J V De Giovanni, A Dindar, M J Griffith, R A Edgar, E D Silove, O Stumper, and J. C Wright Recovery pattern of left ventricular dysfunction following radiofrequency ablation of incessant supraventricular tachycardia in infants and children Heart, June 1, 1998; 79(6): 588 - 592. [Abstract] [Full Text]

				A. S. Manolis, P. J. Wang, and N. A. M. Estes Radiofrequency Catheter Ablation for Cardiac Tachyarrhythmias Ann Intern Med, September 15, 1994; 121(6): 452 - 461. [Abstract] [Full Text]

				L. L. Creswell, M. Rosenbloom, J. S. Pirolo, J. E. Saffitz, and J. L. Cox Potential ablation of accessory atrioventricular pathways: Injection of alcohol into the atrioventricular groove Ann. Thorac. Surg., January 1, 1994; 57(1): 203 - 207. [Abstract] [PDF]

				T. S. Klitzner, G. T. Wetzel, L. A. Saxon, and W. G. Stevenson Radiofrequency Ablation: A New Era in the Treatment of Pediatric Arrhythmias Arch Pediatr Adolesc Med, July 1, 1993; 147(7): 769 - 771. [Abstract] [PDF]

				J. Vatz, S. C. Hammill, and D. Cooke Radiofrequency Catheter Ablation of Aberrant Conducting Pathways of the Heart JAMA, October 21, 1992; 268(15): 2091 - 2098. [PDF]