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33rd International Congress on Electrocardiology

International Society of Electrocardiology

Catheter Ablation of Atrioventricular Reciprocating Tachycardia in Children

Meeting Abstract

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33rd International Congress on Electrocardiology. Cologne, 28.06.-01.07.2006. Düsseldorf, Köln: German Medical Science; 2007. Doc06ice003

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Published: February 8, 2007

© 2007 Rosenthal.
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Radiofrequency ablation was first used clinically in 1987 and paediatric use soon followed. The first report in 1992 in 189 children from 13 centres had a high procedural success with low rates of complications. Indications for the procedure have evolved over the ensuing years. Initially only patients with life-threatening arrhythmias, those whose symptoms were refractory to medication or had unacceptable side effects or where cardiac surgery was due to be performed underwent the procedure. Currently the major indication is patient or parental choice and in many it is used as first line treatment. Radiofrequency ablation is not offered as a routine to smaller children (under 15.0 kg in weight or less than 4 years of age) however, due to the slightly increased risk of complications. In addition in neonates and infants, the incidence of spontaneous resolution of the arrhythmia substrate is very high.

In patients with a structurally normal heart, the success rate is now 99% for dual atrioventricular nodal re-entry and over 95% for most accessory pathways. The lowest success rate remains in right sided anteroseptal pathways with a success rate of 86%. The recurrence rate has been studied prospectively in children and is around 5% for AV nodal re-entry, 10% for left sided accessory pathways, 15% for right sided pathways and 25 % for right septal accessory pathways.

The presence of structural heart disease reduces the acute success rate significantly due to the higher incidence of right sided and multiple pathways. Catheter stability on the atrioventricular groove is also difficult in patients with Ebstein’s anomaly which is present in a third of cases. Long-term success is found in 2/3 of patients.

The frequency of complications has reduced with heart block in about 1% of patients. Deaths have been reported infrequently and were associated with lower patient weight and the presence of structural heart disease. Some of these remain unexplained but in others trauma to the mitral valve, coronary artery or tamponade was present.

In an attempt to reduce the incidence of heart block and coronary artery damage, cryoablation has begun to be used. The catheters for this are less easy to manipulate than those used for radiofrequency ablation and the acute success rate is lower with a higher recurrence. The control of the lesion formation means that heart block is not encountered and its major role is therefore in septal accessory pathways.

Catheter ablation has evolved to become an acceptable first choice management of supraventricular tachycardias in children.