title: Percutaneous radiofrequency catheter ablation for supraventricular arrhythmias in children.
abstract: Nineteen procedures were performed in 17 children, aged 10 months to 17 years, using catheter radiofrequency applications for the management of malignant or drug-resistant supraventricular tachyarrhythmias. Diagnoses were junctional ectopic tachycardia in 1 patient, atrioventricular (AV) node reentrant tachycardia in 4 and accessory pathway-mediated tachycardia in 12. Accessory pathway locations were left lateral (n = 4), posteroseptal (n = 3), left posterior (n = 2), right posterolateral (n = 1), right posterior paraseptal (n = 1), right intermediate septal (n = 1) and right anterior (n = 1). Ablation of accessory pathways was performed using 20 to 40 W of energy. The catheter was passed retrograde to the left ventricle in patients with a left-sided pathway and anterograde to the right atrium in those with a right-sided or posteroseptal pathway. In the 12 patients with an accessory pathway, radiofrequency applications were successful in 11 pathways and failed in 2. There were no recurrences of accessory pathway-mediated tachycardia. Atrioventricular node reentrant tachycardia was treated by AV node modification using 15 W of energy applied until first degree AV block occurred. After radiofrequency catheter ablation, there was a prolonged AH interval, tachycardia was not inducible and tachycardia recurred in one patient. For the patient with junctional ectopic tachycardia, 15 to 18 W of energy was delivered at the site of the maximal His bundle electrogram until sinus rhythm and normal AV conduction appeared. After a recurrence, a second procedure abolished tachycardia and AV conduction. In summary, radiofrequency catheter ablation was initially successful in 17 of 19 procedures and ultimately curative in 14 (82%) of 17 patients with no serious complications. Radiofrequency catheter ablation appears to be a safe and effective method for the management of supraventricular tachyarrhythmias in children.
authors.affiliation: Department of Pediatrics, University of California San Francisco School of Medicine.
authors.forename: G F
authors.initials: GF
authors.lastname: Van Hare
authors.forename: M D
authors.initials: MD
authors.lastname: Lesh
authors.forename: M
authors.initials: M
authors.lastname: Scheinman
authors.forename: J J
authors.initials: JJ
authors.lastname: Langberg
mesh_terms: D000293:Adolescent; D002304:Cardiac Pacing, Artificial; D002648:Child; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011846:Radio Waves; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000601:surgery; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000601:surgery*