Radiofrequency catheter ablation of tachycardia in children with and without congenital heart disease: indications and limitations

From 1993 to 1998, a total of 100 consecutive pediatric patients with tachy cardia (45 male and 55 female, aged 1 year 10 months to 17 years, 11 +/- 4 year) who underwent electrophysiological study were reviewed. Eleven of the m were younger than 5 years. Two had tachycardia-related cerebrovascular ac cident. Congenital heart disease was found in 12 patients. After propofol a nesthesia, the clinical tachycardia could not be induced in three (two atri al tachycardia and one AV nodal re-entrant tachycardia) and became nonsusta ined in five (atrial tachycardia). Mechanical ablation occurred in three an d two had subsequent recurrences. Among the 85 cases who received radiofreq uency ablation, the overall final success rate of RF ablation for all diagn oses was 94% with a diagnosis-specific success rate ranging from 100 to 57% . Tachycardia cardiomyopathy was noted in four (three atrial tachycardia an d one junctional ectopic tachycardia) and all regressed after successful ab lation. Success in two patients with left posterioseptal accessory pathway could only be achieved by delivering the energy at the middle cardiac vein. Two patients with right atrial isomerism had an 'AV nodal-to-AV nodal tach ycardia' which was eliminated by ablation. Total recurrence rate was 13% bu t final success was achieved in all during re-study except the three patien ts who refused re-intervention. The atrial tachycardia developed in postope rative congenital heart disease was associated with the lowest success rate (57%) and highest recurrence rate (25%). Procedure-related complications o ccurred in four; two with transient brachial palsy, one with first-degree A V block and one with blood loss requiring blood transfusion. In conclusion, the experience of this single center confirmed the efficacy and safety of radiofrequency catheter ablation in treating pediatric arrhythmias, but the limitations in postoperative arrhythmias and the effects of propofol on ta chycardia induction (especially the atrial tachycardia) need to be improved . (C) 2000 Elsevier Science ireland Ltd. All rights reserved.