THE LEARNING-CURVE FOR RADIOFREQUENCY ABLATION OF TACHYARRHYTHMIAS INPEDIATRIC-PATIENTS

The results bf radiofrequency ablation for treatment Of supraventricul ar tachyarrhythmias have been reported to improve with increasing expe rience; however, the nature of the learning curve in children is unkno wn. November 1990 to October 1993, 1,546 consecutive procedures from t he Pediatric Radiofrequency Ablation Registry were categorized into de ciles based on number of prior pediatric procedures bt the submitting institution. Negative exponential models were tested for strength of r elation between volume of prior experience and 4 measures of outcome: success rate, complication rate, fluoroscopy time, and procedure time. Negative exponential curves described the experience-outcome relation s well (r = 0.81 to 0.97). Learning rates were most rapid for successf ul ablation of left free wall accessory pathways, and slowest for righ t free wall pathway ablation. These models suggest that, given enough experience, procedural success rates >90% (regardless of pathway locat ion) and fluoroscopy and procedure times averaging <40 minutes and 250 minutes, respectively, can be achieved in pediatric patients.