Comparison of radiofrequency catheter ablation procedures in children, adolescents, and adults and the impact of accessory pathway location.
Radiofrequency (RF) catheter ablation is an accepted treatment for supraventricular tachycardia. However, the determinants of success, difficulty, or risk of complication associated with ablation have not been defined. This study evaluated patient age and location of the accessory or extranodal pathway as determinants of these procedural variables. Patients were stratified by age, with those aged 2 to 12 years classified as children, those aged 13 to 19 years as adolescents, and those > or = 20 years as adults. Locations were defined as right, septal, or left free wall accessory pathways, or extranodal slow pathways associated with atrioventricular node reentrant tachycardia. A total of 443 RF ablation procedures performed in 413 patients were evaluated. All procedures were performed in the same laboratory by the same group of physicians. Success rates for ablation of supraventricular tachycardia did not differ among the 3 age groups, ranging from 93% to 95%. Procedural aspects, including total procedure time, fluoroscopy time, and number of applications of RF energy also did not differ by age group. However, analysis of outcome and procedural complexity with respect to pathway location demonstrated that ablation of right free wall and septal accessory pathways was significantly more difficult than left free wall or slow pathway (success rates of 85% and 88% vs 97% and 98%, respectively, p = 0.01 and 0.02), irrespective of age. Additionally, right free wall pathways required significantly greater procedure time (mean = 5.1 hours), fluoroscopy time (mean = 78 minutes), and RF applications (median = 16) than ablations performed at other sites.(ABSTRACT TRUNCATED AT 250 WORDS)
Park
J K
JK
University Arrhythmia Service, Oregon Health Sciences University, Portland.
Halperin
B D
BD
McAnulty
J H
JH
Kron
J
J
Silka
M J
MJ
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017115:Catheter Ablation / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D006329:Heart Conduction System / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000473:pathology / Q000601:surgery; D013617:Tachycardia, Supraventricular / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome