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Radiofrequency catheter ablation in infants </=18 months old: when is it done and how do they fare?: short-term data
A D Blaufox1, G L Felix, J P Saul
1Childrens' Heart Program of South Carolina, Medical University of South Carolina, Charleston, USA. blaufoad@musc.edu
Insights
Pediatric radiofrequency catheter ablation (RFCA) is safe and effective in infants, even those with structural heart disease. Experienced physicians can successfully use RFCA for drug-resistant arrhythmias in infants.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Ablation
Background:
- Infantile arrhythmias pose significant clinical challenges.
- Radiofrequency catheter ablation (RFCA) is a standard treatment for arrhythmias in older populations.
Purpose of the Study:
- To evaluate the indications, safety, and efficacy of pediatric radiofrequency catheter ablation (RFCA) specifically in infants.
- To compare RFCA outcomes in infants versus non-infants.
Main Methods:
- Retrospective review of the pediatric RFCA registry data.
- Analysis of 152 procedures in 137 infants (0-1.5 years) compared to 6610 procedures in 5960 non-infants.
- Inclusion of data on structural heart disease, patient demographics, and procedural outcomes.
Main Results:
- Infants undergoing RFCA were more likely to have structural heart disease (36% vs 11.2%) and presented with drug-resistant or life-threatening arrhythmias.
- Success rates for RFCA were comparable between infants and non-infants (87.6% vs 90.6%).
- Complication rates were similar between groups (7.8% vs 7.4% total, 4.6% vs 2.9% major), and not influenced by weight, age, or structural heart disease in infants.
Conclusions:
- Pediatric RFCA is a viable and safe option for infants, particularly for drug-resistant arrhythmias.
- The presence of structural heart disease does not preclude successful RFCA in infants.
- Experienced physicians performing RFCA in selected infants achieve favorable outcomes.
Background:
The objective of this study was to determine the indications, the safety, and the efficacy of pediatric radiofrequency catheter ablation (RFCA) in infants.
Methods And Results:
Data from the pediatric RFCA registry were reviewed. Between August 1989 and January 1999, 137 infants, defined by age 0 to 1.5 years (median 0.7 years; weight 1.9 to 14.8 kg, median 10 kg), underwent 152 procedures in 27 of 49 registry centers (55%), compared with 5960 noninfants undergoing 6610 procedures during a comparable period. Structural heart disease was present in 36% of infants, compared with 11.2% of noninfants (P<0.0001). RFCA in infants was performed more commonly for drug resistance or life-threatening arrhythmias than in noninfants. No differences were found between infants and noninfants in success for all tachycardia substrates (87.6% versus 90.6%, P=0.11), for single accessory pathways (94.5% versus 91.5%, P=0.4), or for total (7.8% versus 7.4%, P=1) and major (4.6% versus 2.9%, P=0.17) complications. Neither success for infants with a single accessory pathway nor complications for the entire infant group were related to weight, age, center size, or the presence of structural heart disease. Centers that performed infant procedures, however, enrolled more patients overall in the registry than those that did not perform infant procedures, and successful procedures in infants were performed by more experienced physicians than failed procedures.
Conclusions:
Compared with noninfants, RFCA in infants is usually performed for drug resistance or life-threatening arrhythmias, often in the presence of structural heart disease. The data support the use of RFCA by experienced physicians in selected infants.
