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Catheter Ablation of Tachyarrhythmias in Small Children

By Andrew D. Blaufox


An estimated 80,000-100,000 radiofrequency ablation (RFA) procedures are performed in the United States each year.1 Approximately 1% of these are performed on pediatric patients at centers that contribute data to the Pediatric Radiofrequency Registry.2 Previous reports from this registry have demonstrated that RFA can safely and effectively be performed in pediatric patients.3,4 However, patients weighing less than 15 kg have been identified as being at greater risk for complications.3,4 Consequently, there has been great reluctance to perform RFA in small children such that children weighing less than 15 kg only represent approximately 6% of the pediatric RFA experience2 despite the fact that this age group carries the highest incidence of tachycardia, particularly supraventricular tachycardia (SVT).5 Factors other than the risk of complications contribute to the lower incidence of RFA in this group, including the natural history of the most common tachycardias (SVT), technical issues with RFA in small hearts, and the potential unknown long-term effects of RF applications in the maturing myocardium. Conversely, there are several reasons why ablation may be desirable in small children, including greater difficulties with medical management,6,7,8 the higher risk for hemodynamic compromise during tachycardia in infants with congenital heart disease (CHD), and the inability of these small children to effectively communicate their symptoms thereby making it more likely that their symptoms may go unnoticed until the children become more seriously ill. Before ultimately deciding that catheter ablation is indicated in small children, one must consider which tachycardias are likely to be ablated, the clinical presentation of these tachycardias, alternatives to ablation, the relative potential for success or complications, and modifications of the procedure that might reduce the risk of ablation in this group

Topics: Indian Pacing and Electrophysiology Journal
Publisher: Indian Pacing and Electrophysiology Group
Year: 2005
OAI identifier:

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  1. (1999). Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group [see comments]. Circulation
  2. Natural history of Wolff-Parkinson-White syndrome in infants and children: a review and a report of 28 cases.
  3. Participating Members of the Pediatric Electrophysiology Society. Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry).
  4. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry.
  5. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. New England
  6. (2001). Radiofrequency Catheter Ablation in Infants < 18 Months Old: When is it Done and How Do They Fare? Short-Term Data From the Pediatric Ablation Registry. Circulation
  7. Radiofrequency Catheter Ablation in Small Chhildren: Relationship of Complications to Application Dose.
  8. (1990). Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence [see comments].
  9. Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients.
  10. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients.
  11. (1999). The Dimensions of the Triangle of Koch in Children.
  12. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up.
  13. (1972). Wolff-Parkinson-White syndrome in infants and children. A long- term follow-up study.

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