Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents

We report our experience in radiofrequency catheter ablation between April, 1992 and December, 1998, in which we treated 287 patients less than 18 yea rs of age (mean 14.3 +/- 3.1 years) with supraventricular tachycardia. Acce ssory pathways were the arrhythmic substrate in 252 of the patients (87.8%) , the patients having a total of 265 accessory pathways. Atrioventricular n odal re-entry was the cause of tachycardia in 26 patients (9.0%), while atr ial flutter was detected in the remaining 9 patients (3.1%). We were able s uccessfully to eliminate the accessory pathway in 236 patients (89%), but 2 5 patients had recurrent arrhythmias. Ablation proved successful in all cas es of atrioventricular node re-entry tachycardia, the slow pathway being ab lated in 25 patients, and the fast pathway in only one case. Recurrence of the arrhythmia occurred in three patients (11.5%). We performed a second ab lation in these children, all then proving successful. The ablation was suc cessful in all cases of atrial flutter, with one recurrence (11.1%). Overal l, therefore, ablation was immediately successful in 271 patients (94.4%), with a recurrence of the arrhythmia in 29 cases (10.7%). The incidence of s erious complications was 2.09% There was one late death due to infective en docarditis, 3 patients suffered complete heart block, 1 had mild mitral reg urgitation, and 1 patient developed an haematoma in the groin. We conclude that radiofrequency catheter ablation can now be considered a standard opti on for the management of paroxysmal supraventricular tachycardias in childr en and young adults.