RADIOFREQUENCY CATHETER ABLATION FOR TACHYARRHYTHMIAS IN CHILDREN ANDADOLESCENTS

Background. Although radiofrequency catheter ablation has been used ex tensively to treat refractory supraventricular tachycardia in adults, few data are available on its safety and efficacy in children and adol escents. We reviewed registry data obtained from 24 centers to evaluat e the indications, early results, complications, and short-term follow -up data in young patients who underwent this procedure. Methods. Stan dardized data were submitted for 652 patients who underwent 725 proced ures between January 1, 1991, and September 1, 1992. The mean length o f follow-up was 13.5 months. Results. The median age of the patients w as 13.5 years, and 84 percent of them had structurally normal hearts. The initial success rates for ablation of atrioventricular accessory p athways (508 of 615 procedures) and atrioventricular-node reentry (63 of 76 procedures) were both 83 percent. Greater institutional experien ce in performing ablation in children and location of the accessory pa thway in the left free wall correlated with greater likelihood of sust ained 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 account ed for 45 percent of the failures overall in the series. Atrial ectopi c-focus tachycardia had the highest recurrence rate, The total complic ation rate was 4.8 percent (35 of 725 procedures), and the only variab les 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 goo d success rate and a low complication rate in pediatric patients, espe cially when it is carried out in experienced pediatric cardiology cent ers.