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Radiofrequency catheter ablation for supraventricular tachycardia in a paediatric population: characteristics of tachycardia mechanisms in a subpopulation with early onset

Published online by Cambridge University Press:  25 September 2020

Yamina Schibli ,
Matthias Gass ,
Florian Berger  and
Christian Balmer
Yamina Schibli
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032Zurich, Switzerland
Matthias Gass
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032Zurich, Switzerland Lake Constance Heart Center, Luisenstr. 9, 78464Constance, Germany
Florian Berger
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032Zurich, Switzerland
Christian Balmer*
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032Zurich, Switzerland
*
Author for correspondence: Christian Balmer MD, University Children’s Hospital, Steinwiesstrasse 75, 8032Zürich, Switzerland. Tel: +41 44 266 73 79; Fax +41 44 266 79 81. E-mail: christian.balmer@kispi.uzh.ch
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Abstract

Background:

In children, the first episode of supraventricular tachycardia occurs at various ages. The aim of this study is to describe age-specific tachycardia mechanisms, clinical findings, and outcome in a contemporary cohort of paediatric patients with supraventricular tachycardia.

Methods:

Retrospective analysis of 531 consecutive patients with structurally normal hearts under the age of 18 years who underwent invasive electrophysiological study for supraventricular tachycardia. The study population was divided into two groups, early-onset group (n = 57) and late-onset group (n = 474), according to the age of the occurrence of the first tachycardia before or after the age of 12 months.

Results:

Accessory pathway-mediated tachycardia was more common (82.5 versus 50.1%, p < 0.001) and the proportion of left-sided accessory pathways was more pronounced (74.5 versus 53.7%, p = 0.01) in the early-onset group than in the late-onset group. The antegrade and retrograde refractory periods of the accessory pathways were similar in both groups, but pre-excitation was more common in the early-onset group (50.9 versus 31.9%, p = 0.007). Typical atrioventricular nodal re-entrant tachycardia was more common (36.7 versus 7.0%, p < 0.001) in the late-onset group. There was no difference among the two groups regarding overall outcome.

Conclusion:

Accessory pathway-mediated re-entrant tachycardia is the most common mechanism of recurrent supraventricular tachycardia in infants with structurally normal hearts who are later referred to an electrophysiological study. These pathways often cause pre-excitation and tend to be located on the left side whereas their refractory period is not different from that of patients with late-onset tachycardia.

Keywords

Supraventricular tachycardiachildreninfantaccessory pathwayelectrophysiological studyradiofrequency catheter ablation
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1383 - 1388
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Ludomirksy, A, Garson, A. Supraventricular Tachycardia. In: Garson, A Jr., Bricker, JT, McNamara, DG. The Science and Practice of Pediatric Cardiology. Vol. III. Philadelphia/London: Lea & Febiger; 1990.Google Scholar
Wu, MH, Chen, HC, Kao, FY, Huang, SK. Postnatal cumulative incidence of supraventricular tachycardia in a general pediatric population: a national birth cohort database study. Heart Rhythm. 2016; 13: 2070–2075.CrossRefGoogle Scholar
Abrams, DJ. Invasive electrophysiology in paediatric and congenital heart disease. Heart. 2007; 93: 383–391.CrossRefGoogle ScholarPubMed
Ko, JK, Deal, BJ, Strasburger, JF, Benson, DW. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am. J. Cardiol. 1992; 69: 1028–1032.CrossRefGoogle ScholarPubMed
Deal, BJ, Keane, JF, Gillette, PC, Garson, A. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. J. Am. Coll. Cardiol. 1985; 5: 130–135.CrossRefGoogle ScholarPubMed
Cannon, BC, Snyder, CS. Disorders of cardiac rhythm and conduction. Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adult. 8th ed. 2013.Google Scholar
Cosío Francisco, G, Anderson Robert, H, Kuck, K-H, et al. Living Anatomy of the Atrioventricular Junctions. A Guide to Electrophysiologic Mapping. Circulation. 1999; 100: e31–e37.Google Scholar
Moak, JP. Supraventricular tachycardia in the neonate and infant. Prog Pediatr Cardiol. 2000; 11: 25–38.CrossRefGoogle ScholarPubMed
Saul, JP. Special considerations for ablation in pediatric patients. In: Shoei, K, Huang, MAW. Catheter Ablation of Cardiac Arrhythmias. 2nd ed: Elsevier Health Sciences; 2011.Google Scholar
Hahurij, ND, Gittenberger-De Groot, AC, Kolditz, DP, et al. Accessory atrioventricular myocardial connections in the developing human heart. Circulation. 2008; 117: 2850.CrossRefGoogle ScholarPubMed
Jongbloed, MR, Vicente Steijn, R, Hahurij, ND, et al. Normal and abnormal development of the cardiac conduction system; implications for conduction and rhythm disorders in the child and adult. Differentiation. 2012; 84: 131–148.CrossRefGoogle ScholarPubMed
Perry, JC, Garson, A. Jr. 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
Huang, S, Wood, M, Miller, J. Ablation of free wall accessory pathways. Catheter Ablation of Cardiac Arrhythmias. 2nd ed.: Elsevier; 2010.Google Scholar
Kubuš, P, Vit, P, Gebauer, RA, Materna, O, Janousek, J. Electrophysiologic profile and results of invasive risk stratification in asymptomatic children and adolescents with the Wolff-Parkinson-White electrocardiographic pattern. Circ Arrhythm Electrophysiol. 2014; 7: 218–223.CrossRefGoogle ScholarPubMed
Michelucci, A, Padeletti, L, Mezzani, A, et al. Relationship between age and anterograde refractoriness of the accessory pathway in Wolff-Parkinson-White patients. Cardiology. 1989; 76: 270–273.CrossRefGoogle ScholarPubMed
Chang, RK, Wetzel, GT, Shannon, KM, Stevenson, WG, Klitzner, TS. Age- and anesthesia-related changes in accessory pathway conduction in children with Wolff-Parkinson-White syndrome. Am J Cardiol. 1995; 76: 1074–1076.CrossRefGoogle ScholarPubMed
Jung, HJ, Ju, HY, Hyun, MC, Lee, SB, Kim, YH. Wolff-Parkinson-White syndrome in young people, from childhood to young adulthood: relationships between age and clinical and electrophysiological findings. Korean J Pediatr. 2011; 54:507–511.CrossRefGoogle ScholarPubMed
Gillette, PC, Garson, A Jr., Kugler, JD. Wolff-Parkinson-White syndrome in children: electrophysiologic and pharmacologic characteristics. Circulation. 1979; 60: 1487–1495.CrossRefGoogle ScholarPubMed
Tonkin, AM, Miller, HC, Svenson, RH, Wallace, AG, Gallagher, JJ. Refractory periods of the accessory pathway in the Wolff-Parkinson-White syndrome. Circulation. 1975; 52: 563–569.CrossRefGoogle ScholarPubMed
Kubuš, P, Vít, P, Gebauer, RA, et al. Long-term results of paediatric radiofrequency catheter ablation: a population-based study. EP Europace. 2014: 16; 1808–1813.CrossRefGoogle ScholarPubMed
Saul, JPK, Dale, John. Electrophysiology studies and electrophysiologic therapeutic catheterization. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents 2013.Google Scholar
Cohen, MI, Wieand, TS, Rhodes, LA, Vetter, VL. Electrophysiologic properties of the atrioventricular node in pediatric patients. J Am Coll Cardiol. 1997; 29: 403–440.CrossRefGoogle ScholarPubMed