Long-term results of paediatric radiofrequency catheter ablation: a population-based study.
OBJECTIVE
We aimed to evaluate long-term utilization and results of paediatric radiofrequency catheter ablation (RFCA) in a population-based study.


RESULTS
Data from all three centres performing paediatric RFCA for the whole population of the Czech Republic between 1993 and 2010 were retrospectively reviewed. A total of 708 ablation procedures in 633 consecutive patients <18 years for 716 different substrates were tracked, with accessory pathways = 439 (61.3%) and atrioventricular nodal reentry tachycardia (AVNRT) = 205 (28.6%) being most frequent. Incidence of RFCA reached 0.049 per 1000 children <18 years of age in the recent era (2006-10). Indications included patient preference (68.0%), drug refractoriness (15.5%), asymptomatic Wolff-Parkinson-White pre-excitation (8.4%), and malignant arrhythmia (6.1%). Median follow-up was 13.7 (interquartile range 5.7-21.5) months. Overall acute/long-term success of the primary procedure was 89.1/77.2% (accessory pathways 87.2/77.7%, AVNRT 98.5/84.4%). Re-ablation was performed in 73 of 163 substrates after a primary unsuccessful ablation resulting in a long-term cumulative efficacy of 96.3%. Between 1993-2005 and 2006-10, procedure/fluoroscopy time decreased from median 154/24 to 105/14 min. (P < 0.001 for both). Serious complications occurred in nine patients (1.4%).


CONCLUSIONS
This population-based study could replicate data from previous single- or multi-centre reports confirming RFCA as a safe method of arrhythmia treatment in children with long-term cumulative efficacy exceeding 90% and significant decrease in the procedure and fluoroscopy time during the study period. The need for RFCA can be estimated at ∼0.05/1000 children <18 years using current indication criteria.
Children's Heart Centre, University Hospital Motol, V Úvalu 84, Prague 150 06, Czech Republic peter.kubus@fnmotol.cz.
Peter
P
Kubuš
Paediatric Cardiology, Children's University Hospital, Jihlavská 20, Brno 625 00, Czech Republic.
Pavel
P
Vít
Department of Paediatric Cardiology, University of Leipzig, Heart Centre, Strümpellstrasse 39, Leipzig 04289, Germany.
Roman A
RA
Gebauer
Paediatric Cardiology, Children's University Hospital, Jihlavská 20, Brno 625 00, Czech Republic.
Libor
L
Zaoral
Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, Prague 140 21, Czech Republic.
Petr
P
Peichl
Department of Cardiology, University Hospital Brno, Pekařská 53, Brno 656 91, Czech Republic.
Martin
M
Fiala
Children's Heart Centre, University Hospital Motol, V Úvalu 84, Prague 150 06, Czech Republic.
Jan
J
Janoušek
D058606:Accessory Atrioventricular Bundle / Q000453:epidemiology* / Q000601:surgery*; D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D018153:Czech Republic / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Children; Congenital heart disease; Paediatric; Radiofrequency ablation; Tachycardia