Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-26T08:18:53.389Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcomes of interventional electrophysiology in children under 2 years of age

Published online by Cambridge University Press:  19 December 2011

Christian J. Turner ,
Kai C. Lau  and
Gary F. Sholler
Christian J. Turner*
Affiliation:
The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
Kai C. Lau
Affiliation:
The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
Gary F. Sholler
Affiliation:
The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia Sydney Medical School, University of Sydney, Australia
*
Correspondence to: Dr C. J. Turner, The Heart Centre for Children, Children's Hospital at Westmead, Locked Bag 4001, Westmead New South Wales 2145 Sydney, Australia. Tel: +61 2 9845 2345; Fax: +61 2 9845 2163; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Despite the increasing utilisation of interventional electrophysiology in adults and older children with arrhythmias, there are few data reflecting the safety and efficacy of this procedure in the age group under 2 years.

Aim

We describe our experience in assessing the efficacy and safety with this group of children.

Methods

We undertook a retrospective review of all infants under 2 years of age who underwent an interventional electrophysiology procedure between 1995 and 2009 to determine indications, procedural details, short- and long-term success, and complication rate.

Results

A total of 23 interventional electrophysiology procedures were performed in 17 patients initially under 2 years of age. Of these, three patients had congenital heart disease. The most common indication was arrhythmia resistant to pharmacological agents (59%), with the remaining cases being arrhythmia complicated by cardiovascular instability (41%). There was initial success in 15 patients after the first procedure, with early recurrence in four. Following six repeat procedures, there was long-term success in 15 patients (88%), with three repeat procedures being performed after 2 years of age. There was one non-procedural death related to persisting arrhythmia. There were three minor complications. In one patient, cryotherapy was used successfully.

Conclusions

The interventional electrophysiology procedure is a viable therapeutic option in infants under 2 years with arrhythmia resistant to other conventional medical management.

Keywords

Radiofrequency ablationinfantschildrensupraventricular tachycardiacomplicationssafety
Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 5 , 13 September 2012 , pp. 499 - 506
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Blaufox, AD, Felix, GL, Saul, JP. Pediatric catheter ablation R. Radiofrequency catheter ablation in infants </=18 months old: when is it done and how do they fare?: short-term data from the pediatric ablation registry. Circulation 2001; 104: 2803–2808.CrossRefGoogle Scholar
2.Case, CL. Radiofrequency catheter ablation of arrhythmias in infants and small children. Prog Pediatr Cardiol 2000; 11: 77–82.CrossRefGoogle ScholarPubMed
3.Weindling, SN, Saul, JP, Walsh, EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. Am Heart J 1996; 131: 66–72.CrossRefGoogle ScholarPubMed
4.Erickson, CC, Walsh, EP, Triedman, JK, Saul, JP. Efficacy and safety of radiofrequency ablation in infants and young children <18 months of age. Am J Cardiol 1994; 74: 944–947.CrossRefGoogle ScholarPubMed
5.Aiyagari, R, Saarel, EV, Etheridge, SP, Bradley, DJ, Dick, M II, Fischbach, PS. Radiofrequency ablation for supraventricular tachycardia in children < or =15 kg is safe and effective. Pediatr Cardiol 2005; 26: 622–626.CrossRefGoogle ScholarPubMed
6.Blaufox, AD, Paul, T, Saul, JP. Radiofrequency catheter ablation in small children: relationship of complications to application dose. Pacing Clin Electrophysiol 2004; 27: 224–229.CrossRefGoogle ScholarPubMed
7.Blaufox, AD. Catheter ablation of tachyarrhythmias in small children. Indian Pacing Electrophysiol J 2005; 5: 51–62.Google ScholarPubMed
8.Deal, BJ, Keane, JF, Gillette, PC, Garson, A Jr. Wolff–Parkinson–White syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol 1985; 5: 130–135.CrossRefGoogle ScholarPubMed
9.Saul, JP, Hulse, JE, Papagiannis, J, Van Praagh, R, Walsh, EP. Late enlargement of radiofrequency lesions in infant lambs. Implications for ablation procedures in small children. Circulation 1994; 90: 492–499.CrossRefGoogle ScholarPubMed
10.BÖKenkamp, R, Wibbelt, G, Sturm, M, et al. Effects of intracardiac radiofrequency current application on coronary artery vessels in young pigs. J Cardiovasc Electrophysiol 2000; 11: 565–571.CrossRefGoogle ScholarPubMed
11.Paul, T, Bokenkamp, R, Mahnert, B, Trappe, HJ. Coronary artery involvement early and late after radiofrequency current application in young pigs. Am Heart J 1997; 133: 436–440.CrossRefGoogle ScholarPubMed
12.Kugler, JD, Danford, DA, Deal, BJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. N Engl J Med 1994; 330: 1481–1487.CrossRefGoogle ScholarPubMed
13.Kugler, JD, Danford, DA, Houston, K, Felix, G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997; 80: 1438–1443.CrossRefGoogle ScholarPubMed
14.Paul, T, Kakavand, B, Blaufox, AD, Saul, JP. Complete occlusion of the left circumflex coronary artery after radiofrequency catheter ablation in an infant. J Cardiovasc Electrophysiol 2003; 14: 1004–1006.CrossRefGoogle ScholarPubMed
15.Blaufox, AD, Saul, JP. Acute coronary artery stenosis during slow pathway ablation for atrioventricular nodal reentrant tachycardia in a child. J Cardiovasc Electrophysiol 2004; 15: 97–100.CrossRefGoogle ScholarPubMed
16.Minich, LLA, Snider, AR, Dick, M Jr. Doppler detection of valvular regurgitation after radiofrequency ablation of accessory connections. Am J Cardiol 1992; 70: 116–117.CrossRefGoogle ScholarPubMed
17.Van Hare, GF, Colan, SD, Javitz, H, et al. Prospective assessment after pediatric cardiac ablation: fate of intracardiac structure and function, as assessed by serial echocardiography. Am Heart J 2007; 153: 815–820.CrossRefGoogle ScholarPubMed
18.Noë, P, Van Driel, V, Wittkampf, F, Sreeram, N. Rapid recovery of cardiac function after catheter ablation of persistent junctional reciprocating tachycardia in children. Pacing Clin Electrophysiol 2002; 25: 191–194.CrossRefGoogle ScholarPubMed
19.Schaffer, MS, Gow, RM, Moak, JP, Saul, JP. Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry). Am J Cardiol 2000; 86: 639–643.CrossRefGoogle ScholarPubMed
20.Van Hare, GF, Javitz, H, Carmelli, D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 2004; 15: 759–770.CrossRefGoogle ScholarPubMed
21.Wang, S, Zhu, S, Hamilton, RM, Kirsh, JA, Stephenson, EA, Gross, GJ. Diagnosis-specific characteristics of ventricular tachycardia in children with structurally normal hearts. Heart Rhythm 2010; 7: 1725–1731.CrossRefGoogle ScholarPubMed
22.Freedom, RM, Lee, KJ, MacDonald, C, Taylor, G. Selected aspects of cardiac tumors in infancy and childhood. Pediatr Cardiol 2000; 21: 299–316.CrossRefGoogle ScholarPubMed
23.Makhoul, M, Von Bergen, NH, Rabi, F, Gingerich, J, Evans, WN, Law, IH. Successful transcatheter cryoablation in infants with drug-resistant supraventricular tachycardia: a case series. J Interv Card Electrophysiol 2010; 29: 209–215.CrossRefGoogle ScholarPubMed
24.Shah, MJ, Wieand, T, Vetter, VL. Cryoablation of congenital familial ectopic tachycardia with preservation of atrioventricular nodal function in an infant. J Cardiovasc Electrophysiol 2007; 18: 773–776.CrossRefGoogle ScholarPubMed
25.Kriebel, T, Hermann, HP, Schneider, H, et al. Cryoablation at growing myocardium: no evidence of coronary artery obstruction or intimal plaque formation early and late after energy application. Pacing Clin Electrophysiol 2009; 32: 1197–1202.CrossRefGoogle ScholarPubMed
26.Friedman, PL, Dubuc, M, Green, MS, et al. Catheter cryoablation of supraventricular tachycardia: results of the multicenter prospective “frosty” trial. Heart Rhythm 2004; 1: 129–138.CrossRefGoogle ScholarPubMed
27.Khairy, P, Chauvet, P, Lehmann, J, et al. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003; 107: 2045–2050.CrossRefGoogle ScholarPubMed
28.Fenrich, AL. Flecainide and amiodarone: combined therapy for refractory tachyarrhythmias in infancy. J Am Coll Cardiol 1995; 25: 1195–1198.CrossRefGoogle ScholarPubMed
29.Price, JF, Kertesz, NJ, Snyder, CS, Friedman, RA, Fenrich, AL Jr. Flecainide and sotalol: a new combination therapy for refractory supraventricular tachycardia in children <1 year of age. J Am Coll Cardiol 2002; 39: 517–520.CrossRefGoogle ScholarPubMed
30.Saul, JP, Scott, WA, Brown, S, et al. Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation 2005; 112: 3470–3477.CrossRefGoogle ScholarPubMed
31.De Giovanni, JV, Dindar, A, Griffith, MJ, et al. Recovery pattern of left ventricular dysfunction following radiofrequency ablation of incessant supraventricular tachycardia in infants and children. Heart 1998; 79: 588–592.CrossRefGoogle ScholarPubMed
32.Friedman, RA, Walsh, EP, Silka, MJ, et al. NASPE Expert Consensus Conference: radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol 2002; 25: 1000–1017.CrossRefGoogle Scholar