Hostname: page-component-76fb5796d-x4r87 Total loading time: 0 Render date: 2024-04-25T12:46:30.130Z Has data issue: false hasContentIssue false
  • English
  • Français

Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents

Published online by Cambridge University Press:  19 August 2008

Pedro Iturralde ,
Luís Colín ,
Sergio Kershenovich ,
Milton E. Guevara ,
Argelia Medeiros ,
Alfonso Buendia  and
Fause Attie
Pedro Iturralde*
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
Luís Colín
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
Sergio Kershenovich
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
Milton E. Guevara
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
Argelia Medeiros
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
Alfonso Buendia
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
Fause Attie
Affiliation:
Departments of Electrophysiology and Paediatric Cardiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, México DF, Mexico
*
Pedro Iturralde MD, Department of Electrophysiology, Instituto Nacional de Cardiologia “Ignacio Chavez”, Juan Badiano I, Tlalpan, 14080 México DF.Mexico, Tel: (52) 5–573–2911; Fax: (52) 5–5730.
Get access Rights & Permissions [Opens in a new window]

Abstract

We report our experience in radiofrequency catheter ablation between April, 1992 and December, 1998, in which we treated 287 parients less than 18 years of age (mean 14.3±3.1 years) with supraventricular tachycardia. Accessory pathways were the arrhythmic substrate in 252 of the patients (87.8%), the patients having a total of 265 accessory pathways. Atrioventricular nodal re-entry was the cause of tachycardia in 26 patients (9.0%), while atrial flutter was detected in the remaining 9 patients (3.1%). We were able successfully to eliminate the accessory pathway in 236 patients (89%), but 25 patients had recurrent arrhythmias. Ablation proved successful in all cases of atrioventricular node re-entry tachycardia, the slow pathway being ablated in 25 patients, and the fast pathway in only one case. Recurrence of the arrhythmia occurred in three patients (11.5%). We performed a second ablation in these children, all then proving successful. The ablation was successful in all cases of atrial flutter, with one recurrence (11.1%). Overall, therefore, ablation was immediately successful in 271 patients (94.4%), with a recurrence of the arrhythmia in 29 cases (10.7%). The incidence of serious complications was 2.09% There was one late death due to infective endocarditis, 3 patients suffered complete heart block, 1 had mild mitral regurgitation, and 1 patient developed an haematoma in the groin. We conclude that radiofrequency catheter ablation can now be considered a standard option for the management of paroxysmal supraventricular tachycardias in children and young adults.

Keywords

Radiofrequency catheter ablationaccessory pathwayschildrenyoung adults
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 4 , July 2000 , pp. 376 - 383
Copyright
Copyright © Cambridge University Press 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Jackman, WM, Wang, X, Friday, KJ et al. Catheter ablation of accessory atrioventricular pathways (WPW syndrome) by radiofrequency current. N Eng J Med 1991;324:1605–1611.CrossRefGoogle ScholarPubMed
Calkins, H, Langberg, JJ, Sousa, JV, Atassir, EL, León, A, Kou, W, Morady, KF. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome. Circulation 1992;85:1337–1346.CrossRefGoogle ScholarPubMed
Feld, GK. Catheter ablation for the treatment of atrial tachycardias. Prog Cardiovasc Dis 1995;37:205–224.CrossRefGoogle Scholar
Haissaguerre, M, Gaita, F, Fischer, B, Comenges, D, Montserrat, P, D'lvernois, CH.Elimination of atrioventricular nodal reentrant tachycardia using discrete slow potentials to guide application of radiofrequency energy. Circulation 1992;85:2162–2175.CrossRefGoogle ScholarPubMed
Jackman, WM, Beckman, KS, McClelland, JH et al. , Treatment of supraventricular tachycardia due to atrioventricular nodal re-entry by radiofrequency catheter ablation of slow pathway conduction. N Eng J Med 1992;327:313–318.CrossRefGoogle Scholar
Warin, JF, Haissaguerre, M, D'uvernoias, , Le Metayer, F, Montserrat, P.Catheter ablation of accessory pathways. Technique and results in 248 patients. PACE 1990;13:1609–1614.CrossRefGoogle ScholarPubMed
Kay, GN, Ebstein, AE, Dailey, SM, Plumb, VJ Selective radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia. Evidence for involvement of perinodal myocardium within the re-entrant circuit. Circulation 1992;85:1675–1688.CrossRefGoogle Scholar
Morady, F, Schemman, MM, Winston, SA. Efficacy and safety of transcatheter ablation of posteroseptal accessory pathways. Circulation 1985;72:170–177.CrossRefGoogle ScholarPubMed
Case, CL, Gillete, OC, Oslizlok, PC, Knick, BJ, Blair, Hl. Radiofrequency catheter ablation of incessant, medically resistant supraventricular tachycardia in infants and small children. J Am Coll Cardiol 1992;20:1405–1410.CrossRefGoogle ScholarPubMed
Kuck, KH, Schluter, M, Gursoy, M. Preservation of atrioventricular nodal conduction during radiofrequency current catheter ablation of midseptal accessory pathways. Circulation 1992;86:1743–1752.CrossRefGoogle ScholarPubMed
Kuck, KH, Schluter, M, Geiger, M, Siebels, J, Duckeck, W. Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet 1991;337:1557–1561.CrossRefGoogle ScholarPubMed
Anderson, RH, Becker, AE. Zipes, DP (ed)Anatomy of the conduction tissues and accessory atrioventricular connections. In: -Cardiac Electrophysiology. From the Cell to the Bedside 1980. Philadelphia: WB Saunders Company, 1990: pp 240–248.Google Scholar
Feld, GK, Fleck, RP, Chen, PS. Radiofrequency catheter ablation for the treatment of human type I atrial flutter. Jdentification of a critical zone in the re-entrant circuit by endocardial mapping techniques. Circulation 1992;86:1233–1240.CrossRefGoogle Scholar
Nakagawa, H, Lazzarra, R, Khastgir, T et al. The role of the tricuspid annulus and the Eustachian valve rigde on atrial flutter: relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation 1996;93:407–424.CrossRefGoogle Scholar
Cauchemez, B, Haissaguerre, M, Fischer, B, Thomas, O, Clementy, J, Coumel, P.Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Ciruculation 1996;93:284–294.CrossRefGoogle ScholarPubMed
Anderson, RH, Yen Ho, S, Gillette, PC, Becker, AE.Mahaim, Kent and abnormal atrioventricular conduction. Cardiovasc Res 1996;31:480–491.CrossRefGoogle ScholarPubMed
Cohen, MI, Wirand, T, Rhodes, LA, Vetter, VL. Electrophysiologic properties of the atrioventricular node in pediatric patients. J Am Coll Cardiol 1997, 29:403–407.CrossRefGoogle ScholarPubMed
Van Hare, GF.Electrical/Ablational therapeutic cardiac catheterization. Pediatr Cardiol 1998;19:95–105.CrossRefGoogle ScholarPubMed
Habe, J, Schluter, M, Kuck, KH. Catheter ablation in children with supraventricular tachycardia mediated by accessory pathways. Use of radiofrequency current as a first line of therapy. Cardiol Young 1994;4:28–36.CrossRefGoogle Scholar
Tanel, RE, Walsh, EP, Triedman, JK, Epstein, MR, Bergau, DM, Saul, JP.Five-year experience with radiofrequency catheter ablation: implications for management of arrhythmias in paediatric and young adult patients. J Pediatr 1997;131:878–887.CrossRefGoogle ScholarPubMed
Dick, M, O'Connor, BK, Serwer, GA, Le Roy, S, Armstrong, B.Use of radiofrequency current to ablate accessory connections in children. Circulation 1991;84:2318–2324.CrossRefGoogle ScholarPubMed
Gillete, PC, Wampler, DG, Garson, AJ, Zinner, A, Cooley, D.Treatment of atrial automatic tachycardia by ablation procedures. J Am Coll Cardiol 1987;6:405–409.CrossRefGoogle Scholar
Bromberg, BI, Dick, MI, Scott, WA, Morady, F.Transcatheter electrical ablation of accessory pathway in children. PACE 1989;12:1787–1796.CrossRefGoogle ScholarPubMed
Saul, JP, Hulse, JE, Wang, DE, Weber, A, Rhodes, A, Lock, JE, Walsh, EP.Catheter ablation of accessory atrioventricular pathways in young patients. Use of long vascular sheaths, the transseptal approach and a retrograde left posterior parallel approach. J Am Coll Cardiol 1993;21:571–583.CrossRefGoogle Scholar
Van Hare, GF, Lesh, MD, Scheinman, M, langberg, JJ. Percutaneous radiofrequency catheter ablation for supraventricular arrhythmias in children. J Am Coll Cardiol 1991;17:1613–1620.CrossRefGoogle ScholarPubMed
Walsh, EP, Saul, JP. Transcatheter ablation for pediatric tachyarrhythmias using radiofrequency electrical energy. Pediatr Annals 1991, 20: 386–392.CrossRefGoogle ScholarPubMed
Kugler, JD, Danford, DA, Houston, K, Felix, G, and Members of the Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997;80:1438–1443.CrossRefGoogle Scholar
Schluter, M, Kuck, KH, Geiger, M, Siebels, J, Duckeck, W.Radiofrequency current for catheter ablation of accessory atrioventricular connections in children and adolescents. Pediatrics 1992;89:930–935.CrossRefGoogle ScholarPubMed
Perry, JC, Garson, AJ Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children. Early disappearance and late recurrence. J Am Coll Cardiol 1990;16:1215–1220.CrossRefGoogle ScholarPubMed
Mantakas, ME, McCue, CM, Miller, WW. Natural history of Wolff-Parkinson-White syndrome discovered in infancy. Am J Caridol 1978;41:1097–1103.CrossRefGoogle ScholarPubMed
Kantoch, MJ, McKay, R.. Lesions produced by radiofrequency ablation in a child. Cardiol Young 1998;4:532ndash;533.CrossRefGoogle Scholar
Schluter, M, Kuck, KH.Catheter ablation form right atrium of anteroseptal accessory pathways using radiofrequency current. J Am Coll Cardiol 1992;19:633–670.CrossRefGoogle Scholar
Natale, A, Wathen, M, Yee, R, Wolfe, K.Atrial and ventricular approaches for radiofrequency catheter ablation of left-sided accessory pathways. Am J Cardiol 1992;70:114–116.CrossRefGoogle ScholarPubMed
Swarts, JF, Cohen, AL, Fletcher, RD. Right coronary epicardial mapping improves accessory pathway catheter ablation success. Circulation 1989;80:Suppl. II:1–431.Google Scholar
Jaeggi, E, Lau, KC, Cooper, SG. Successful radiofrequency ablation in a infant with drug resistant permanent junctional reciprocationg tachycardia. Cardiol Young 1999;6:621–623.CrossRefGoogle Scholar
Lesh, D, Van Hare, GF, Schamp, DJ et al. Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations. Results in 100 consecutive patients. J Am Coll Cardiol 1992;19:1303–1309.CrossRefGoogle ScholarPubMed
Kadish, A, Goldberg, RJ.Ablative therapy for atrioventricular nodal re-entry arrhythmias. Prog Cardiovasc Dis 1995;37:273–293.CrossRefGoogle Scholar
Kalbfleisch, SJ, Strickberger, A, Williamson, B, Vorperian, VR, Man, EH, Kummel, JD. Randomised comparison of anatomic and electrogram mapping approaches to ablation of the slow pathway of atriventricular node re-entrant tachycardia. J Am Coll Cardiol 1994;23:716–723.CrossRefGoogle Scholar
Wu, D, Yeh, S, Wang, C.A simple technique for selective radiofrequency ablation of the slow pathway in atrioventricular node re-entrant tachycardia. J Am Coll Cardiol. 1993, 21:1612–1621.CrossRefGoogle Scholar
Kay, FN, Ebstein, AE, Dailey, SM, Plumb, VJ.Role of radiofrequency ablation in the management of supraventricular arrhythmias. J Cardiovasc Electrophysiol 1993, 4:371–389.CrossRefGoogle ScholarPubMed