Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry)

Deaths have been reported following radiofrequency catheter ablation (RFCA) , but the mortality rate in children has not been defined, This study sough t to analyze the incidence and the factors associated with mortality relate d to RFCA, Ten of 4,651 cases (0.22%) reported to the Pediatric RFCA Regist ry resulting in death were reviewed and compared with a matched control gro up (n = 18), Death occurred in 5 of 4,092 children (0.12%, ages 0.1 to 13.3 years) with structurally normal hearts. Death was related to traumatic inj ury, myocardial perforation and hemopericardium, coronary or cerebral throm boembolism, and ventricular arrhythmia. All cases were left-sided (p = 0.01 9 vs right or septal) supraventricular arrhythmias with radiofrequency appl ications in the systemic atrium and/or ventricle, and all procedures were s uccessful, Mortality occurred in 5 of 559 children (0.89%, p = 0.001 vs nor mals, ages 1.5 to 17.4 years) with structural heart disease, No new patholo gy except the mural radiofrequency lesions was seen at autopsy. Those with structurally normal hearts who died were smaller (32.7 vs 55.6 kg, p = 0.02 3) and had more radiofrequency applications (26.3 vs 8.7, p = 0.019) than t hose who survived. No differences were demonstrated for those with abnormal hearts. Operator experience was not different (deaths 103 +/- 106 vs contr ols 117 +/- 125, p = 0.41). Mortality associated with pediatric RFCA is rar e, but is more frequent when there is underlying heart disease, lower patie nt weight, greeter number of radiofrequency energy applications, and left-s ided procedures. Operator experience does not appear to be a factor leading to mortality. (C) 2000 by Excerpta Medica, Inc.