Low temperature and low energy radiofrequency modification of atrioventricular nodal slow pathways in pediatric patients.
OBJECTIVE
To report our experience using low temperature and energy in the modification of the slow pathway in pediatric patients with atrioventricular nodal reentrant tachycardia.


BACKGROUND
A concern in performing a slow pathway modification is the possible damage of the normal AV conduction system. Lesion size has been shown to have a linear relationship with temperature. Previous reports have used energy of 25-50 W that generate temperatures of 60 degrees C -70 degrees C for successful procedures.


METHODS
Report of results of attempted AV nodal slow pathway modification in 17 consecutive pediatric patients < 15 years of age at The Children's Hospital of Philadelphia from April 1995 to November 1997 using low temperature and energy.


RESULTS
There were 18 successful slow pathway modifications with 1 recurrence in 17 patients. The maximum energy used during successful lesions was 32.7 +/- 13.8 W (range 15-50 W) with a mean energy of 26.4 +/- 13.3 W (range 12-48 W). The peak temperature during these lesions was 55.1 degrees C +/- 4.1 degrees C (range 48 degrees C-64 degrees C) with a mean temperature of 47.9 degrees C +/- 2.7 degrees C (range 44 C-540C). The mean number of radiofrequency lesions required for a successful modification was 5.8 +/- 6.7 (median 4.0, range 1-26). Patients have been followed for 2.08 +/- 0.79 years.


CONCLUSIONS
Slow pathway modification can be performed successfully with a low incidence of recurrence in the pediatric patient using low energy and temperature. It is possible that this may lead to smaller lesions.
Rhodes
L A
LA
Division of Cardiology, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA. rhodes@email.chop.edu
Wieand
T S
TS
Vetter
V L
VL
D000293:Adolescent; D001283:Atrioventricular Node / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000295:instrumentation*; D002648:Child; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013696:Temperature; D016896:Treatment Outcome