[Catheter ablation of accessory pathways in patients with congenital cardiopathies]

The catheter ablation procedure in patients with accessory pathways and congenital heart defects can potentially become complicated because of abnormal anatomy and atypical conduction system. Eight patients ranging in age from 4.5 months to 18 years with accessory pathways and congenital heart defects underwent radiofrequency ablation. The cardiac diseases were diagnosed as Ebstein anomaly (n = 3), cardiac rhabdomyomas (n = 1), double outlet right ventricle (n = 1), endocardial cushion defect, partial form (n = 1), repaired Fallot's tetralogy (n = 1) and interventricular septal defect (n = 1). Six patients had manifest Wolff-Parkinson-White syndrome and 2 had concealed pathways. One patient with Ebstein anomaly had multiple accessory pathways. Radiofrequency ablation was initially successful in eight of the nine accessory pathways (89%). Two procedures were performed in one patient for pathway recurrence. Procedure was unsuccessful in 1 patient with Ebstein anomaly who later had surgical interruption of the accessory pathway. After a mean follow-up of 30.9 +/- 16.4 months, six of the 7 patients in which pathways were successfully ablated are tachycardia-free. One patient had late recurrence of tachycardia and is well controlled by propafenone.