Radiofrequency catheter ablation of incessant, medically resistant supraventricular tachycardia in infants and small children

Division of Pediatric Cardiology, South Carolina Children's Heart Center, Medical University of South Carolina, Charleston 29425.

OBJECTIVES. This study retrospectively evaluates initial experience with radiofrequency catheter ablation in a group of seven infants and small children with a history of incessant, medically resistant supraventricular tachycardia. METHODS. Before attempted catheter ablation, all patients had had unsuccessful conventional medical therapy (with digoxin or propranolol, or both) and, in addition, each continued to have daily episodes of supraventricular tachycardia while taking amiodarone or a class IC antiarrhythmic agent alone or in combination. The average patient age was 10 months (range 1 to 27) and the average patient weight was 6 kg (range 3 to 13). Electrophysiologic diagnosis included reentrant supraventricular tachycardia in six patients and atrial ectopic tachycardia in one patient. RESULTS. These seven patients underwent a total of nine catheter ablation procedures. The atrial approach to ablation was employed in eight of the nine procedures. Overall, radiofrequency catheter ablation was totally successful in five of the seven patients, partially successful in one patient and unsuccessful in the remaining patient. The combination of radiofrequency catheter ablation and surgical ablation was successful in controlling tachycardia in all patients; with at least 5 months of follow-up study, no patient has had a recurrence of supraventricular tachycardia or reappearance of a delta wave. CONCLUSIONS. Surgical ablation of arrhythmogenic substrates in the pediatric age group, although rarely indicated, has been found in the past to be safe and effective. Our initial experience with radiofrequency catheter ablation in infants and small children demonstrates that this procedure is a promising nonpharmacologic therapeutic alternative to surgical ablation.

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