Radiofrequency ablation in older children and adolescents by an adult electrophysiology team

Background: Radiofrequency (RF) catheter ablation has been widely and succe ssfully employed to cure adult patients of a variety of arrhythmias. Only a few centers have a pediatric electrophysiology (EP) service available and have presented similar results in children. The aim of this study was to in vestigate the efficacy and safety of RF ablation in pediatric patients perf ormed by an adult EP team. Patients and Methods. The study group included 33 consecutive pediatric pat ients, aged 7-18 years (mean 14.1+/-8.1), with symptomatic supraventricular tachyarrhythmias, who underwent RF ablation during the last 3 years. AU bu t two patients underwent a full EP study during the same session. Procedure s were performed in all but five patients with use of local anesthesia and deep or light sedation. The left heart was approached with use of transaort ic (n = 3) or transseptal (n = 7) techniques. RF ablation was performed for manifest (n = 11) or concealed (n = 9) (9 left, 4 anteroseptal, 3 midsepta l, and 4 posteroseptal) or right atriofascicular (Mahaim) (n = 1) accessory pathways in 19 patients, 12 slow AV nodal pathways and 2 atrial tachycardi a foci in the other 14 patients. Results. RF ablation was successful in all patients (100%) with 1-27 RF app lications (mean: 10+/-7). There was one complication in a patient with 2 ac cessory pathways; after RF ablation of a posteroseptal accessory pathway, c omplete heart block occurred during successful ablation of a second midsept al accessory pathway. Fluoroscopy time averaged 35+/-23 min and procedure d uration 2.8+/-1.4 hours. During long-term follow-up of 19+/-10 months, ther e was one AV nodal tachycardia recurrence at 2.5 months, successfully treat ed with repeat RF ablation. Conclusion. RF ablation in pediatric patients performed by an adult EP team is efficacious and safe offering cure of symptomatic cardiac tachyarrhythm ias in this patient population.