[Use of transesophageal pacing for documentation of older children with accessory pathway].
BACKGROUND
In case of an accessory pathway, children are exposed to severe cardiac events including sudden death. Radiofrequency ablation is a standardized procedure, which can be applied to a significant number of children although complications can still potentially occur. In this context, transesophageal evaluation of the accessory pathway evaluation can be discussed.


METHODS
Among 140 procedures performed in 19 years, 70 were done for accessory pathway evaluation. The preexcitation was overt in 59 children older than 5 years, which form the basis in this study.


RESULTS
Anterograde refractory period was determined in 88% cases and was found<220 ms in 12 cases justifying an ablation procedure. Conversely, in case of a long refractory period (>250 ms), the ablation procedure was not performed in 8 asymptomatic cases and was postponed in 11/20 mildly symptomatic children. Transesophageal electrophysiologic study seems legitimate in asymptomatic or mildly symptomatic children.


CONCLUSIONS
This technique is probably less useful in case of an overt preexcitation and recurrent reciprocating tachycardia requiring long-term antiarrythmic treatment. In this case, endocavitary electrophysiological study eventually followed by an ablation procedure seems the best option.
Lucet
V
V
Unité de rythmologie pédiatrique, Château-des-Côtes, 78350 Les-Loges-en-Josas, France. vincent.lucet@centredescotes.com
Do Ngoc
D
D
Denjoy
I
I
D000293:Adolescent; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017115:Catheter Ablation; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D004594:Electrophysiology; D004947:Esophagus / Q000502:physiology; D006801:Humans; D018579:Patient Selection; D013610:Tachycardia / Q000175:diagnosis* / Q000628:therapy; D014693:Ventricular Fibrillation / Q000517:prevention & control