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Previous Volume 330:1481-1487 May 26, 1994 Number 21 Next

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ABSTRACT

Background Although radiofrequency catheter ablation has been used extensively to treat refractory supraventricular tachycardia in adults, few data are available on its safety and efficacy in children and adolescents. We reviewed registry data obtained from 24 centers to evaluate the indications, early results, complications, and short-term follow-up data in young patients who underwent this procedure.

Methods Standardized data were submitted for 652 patients who underwent 725 procedures between January 1, 1991, and September 1, 1992. The mean length of follow-up was 13.5 months.

Results The median age of the patients was 13.5 years, and 84 percent of them had structurally normal hearts. The initial success rates for ablation of atrioventricular accessory pathways (508 of 615 procedures) and atrioventricular-node reentry (63 of 76 procedures) were both 83 percent. Greater institutional experience in performing ablation in children and location of the accessory pathway in the left free wall correlated with greater likelihood of sustained success. Conversely, a right free-wall pathway, the presence of other heart disease, and higher body weight were all associated with a lesser chance of sustained success. Recurrences of arrhythmia accounted for 45 percent of the failures overall in the series. Atrial ectopic-focus tachycardia had the highest recurrence rate. The total complication rate was 4.8 percent (35 of 725 procedures), and the only variables that independently correlated with a higher complication rate were very low weight and less institutional experience.

Conclusions These early results suggest that radiofrequency catheter ablation has a good success rate and a low complication rate in pediatric patients, especially when it is carried out in experienced pediatric cardiology centers.

Source Information

From the Section of Pediatric Cardiology, University of Nebraska Medical Center, Omaha (J.D.K., D.A.D.); Children's Memorial Hospital, Chicago (B.J.D.); South Carolina Children's Heart Center, Charleston (P.C.G.); Texas Children's Hospital, Houston (J.C.P.); Oregon Health Sciences University, Portland (M.J.S.); University of California at San Francisco, San Francisco (G.F.V.H.); and Children's Hospital, Boston (E.P.W.). The other members of the Pediatric Electrophysiology Society who participated in this study are listed in the Appendix according to their study centers (Dr. Danford is not a member).

Address reprint requests to Dr. Kugler at the Section of Pediatric Cardiology, University of Nebraska Medical Center, 600 S. 42nd St., Omaha NE 68198-2166.

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