Ablation of supraventricular tachycardia allows more liberal therapy in some children with attention-deficit-hyperactivity disorder.
BACKGROUND
First-line therapy for children with attention-deficit-hyperactivity disorder (ADHD) is stimulant medication, which may have potential cardiovascular side-effects. In patients with supraventricular tachycardia or Wolf-Parkinson-White syndrome (WPW), therapy for ADHD could become challenging. The purpose of the present study was to review the authors' experience of performing electrophysiologic study (EPS) with or without ablation to determine how it affected ADHD therapy.


METHODS
Retrospective chart review of patients who underwent EPS between 2002 and 2009 was carried out. All patients under 21 years of age who had prior diagnosis of ADHD were included.


RESULTS
Twenty patients met the inclusion criteria. The mean age was 12.1 ± 2.7 years (range: 5.6-16.8 years). The patients were diagnosed with ADHD on average 3.9 ± 2.7 years (range: 6 months-9 years) prior to the EPS. All patients had a structurally normal heart. Sixteen patients had cardiac symptoms. Seventeen patients underwent ablation of the arrhythmia substrate (16/17, 94% successful). Three patients with asymptomatic WPW were at low risk for life-threatening arrhythmias and did not have ablation. After the EPS, two patients had increased doses of their ADHD medications, and two patients whose health-care providers stopped the stimulant medication prior to EPS because of recurrent tachycardia were restarted on medications. All other patients on ADHD medications continued therapy.


CONCLUSIONS
EPS for risk stratification and ablation of arrhythmia substrate is safe and effective, allowing more liberal therapy in patients with ADHD and supraventricular tachycardia or WPW.
Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Ira
I
Shetty
Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Eric S
ES
Silver
Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Allan J
AJ
Hordof
Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Pablo H
PH
Goldberg
Pediatric Arrhythmia Service, Department of PediatricsDepartment of Psychiatry, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Leonardo
L
Liberman
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000188:drug therapy*; D017115:Catheter Ablation; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D013617:Tachycardia, Supraventricular / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D014927:Wolff-Parkinson-White Syndrome / Q000150:complications / Q000601:surgery*
D000697:Central Nervous System Stimulants