RADIOFREQUENCY ABLATION OF ACCESSORY PATHWAYS ASSOCIATED WITH CONGENITAL HEART-DISEASE

The coexistence of significant congenital cardiac disease with accesso ry pathways is not uncommon, and presents a number of issues for clini cal management. These issues include the propensity of such patients t o have poorly tolerated tachycardia; the difficulties in choosing appr opriate medical management given potential problems with preexisting s inus node disease, poor contractility, and the possibility of proarrhy thmia; the need to seriously consider ablation prior to, or at the tim e of, intracardiac repair of congenital cardiac defects; and finally, the difficulties that complex anatomy may pose to the interventional e lectrophysiologist. Definitive management requires expertise both in e lectrophysiology and in pediatric cardiology. Success can usually be a chieved with a careful, anatomically precise approach, combined with i magination and persistence. Because of the difficulties with medical m anagement, catheter ablation may be the most attractive modality for c ontrol of accessory pathway tachycardia in this patient population.