Radiofrequency catheter ablation in infants <= 18 months old - When is it done and how do they fare? Short-term data from the pediatric ablation registry

Background-The objective of this study was to determine the indications, th e safety, and the efficacy of pediatric radiofrequency catheter ablation (R FCA) in infants. Methods and Results-Data from the pediatric RFCA registry were reviewed. Be tween August 1989 and January 1999, 137 infants, defined by age 0 to 1.5 ye ars (median 0.7 years; weight 1.9 to 14.8 kg, median 10 kg), underwent 152 procedures in 27 of 49 registry centers (55%), compared with 5960 noninfant s undergoing 6610 procedures during a comparable period. Structural heart d isease was present in 36% of infants, compared with 11.2% of noninfants (P <0.0001). RFCA in infants was performed more commonly for drug resistance o r life-threatening arrhythmias than in noninfants. No differences were foun d between infants and noninfants in success for all tachycardia substrates (87.6% versus 90.6%, P=0.11), for single accessory pathways (94.5% versus 9 1.5%, P=0.4), or for total (7.8% versus 7.4%, P=1) and major (4.6% versus 2 .9%, P=0.17) complications. Neither success for infants with a single acces sory pathway nor complications for the entire infant group were related to weight, age, center size, or the presence of structural heart disease. Cent ers that performed infant procedures, however, enrolled more patients overa ll in the registry than those that did not perform infant procedures, and s uccessful procedures in infants were performed by more experienced physicia ns than failed procedures. Conclusions-Compared with noninfants, RFCA in infants is usually performed for drug resistance or life-threatening arrhythmias, often in the presence of structural heart disease. The data support the use of RFCA by experience d physicians in selected infants.