Pediatric radiofrequency catheter ablation for supraventricular and ventricular tachyarrhythmias: a single center retrospective analysis

Abstract

Introduction. In recent years radiofrequency catheter ablation (RFCA) has become a standard of care treatment for children and young adults with supraventricular and ventricular tachyarrhythmias. The aim of this study is to evaluate the short-term follow-up of RFCA for ventricular and supraventricular tachyarrhythmias in the pediatric age group. Materials and methods. A total of 63 pediatric patients (mean age at the time of the procedure 12.9±6.7 years, weight 47.98±13.2 Kg), were referred for electrophysiologic study (EPS) and RFCA between April 2004 and April 2018. The electrophysiologic study was performed in a tertiary center using a modified simple technique with the right femoral approach and 2 catheters 5 and 6 French one for stimulation and one for mapping. Referral for the RFCA procedure was done according to the recent guidelines: Class I: WPW syndrome and recurrent and/or symptomatic SVT and age >5 years; WPW syndrome and palpitations with inducible sustained SVT during EPS, age >5 years; Class IIb: WPW syndrome and recurrent and/or symptomatic SVT and age <5 years. Results. A total of 68 EPS procedures were performed in 63 patients. Referral for WPW syndrome in 22 patients (34.9%), atrioventricular node reentry in 20 patients (31.7%), concealed accessory pathways in 8 patients (12.7%), atrial tachycardia in 3 patients (4.8%), atrial flutter in 1 patient (1.6%), permanent ventricular tachycardia was the reason RF ablation in 1 patient (1.6%), premature ventricular beats in 2 patients (3.2%). RFCA was performed under general sedation in 5 patients (7.9%), the rest of the procedures were under exclusively local anesthesia. RFCA success rate was 97.1%, with an arrhythmia recurrence rate of 5.9%. No complications occurred during procedures. In 1 patient (1.6%) with WPW syndrome the mechanical induced atrial fibrillation with hemodynamical compromise needed electrical shock therapy for rhythm control. Mean duration of RFCA was 103.7 min, with a mean radiation exposure time of about 10.5 min and a mean dose of about 1582 μGy/m². A three-dimensional mapping system was needed in 3 RFCA procedures. Conclusion. Radiofrequency catheter ablation is a safe and highly successful option of treatment for the supraventricular and ventricular tachyarrhythmias in pediatric patients. The use of the modified simple technique reduces the risk for major complications.