Radiofrequency ablation in pediatric and adult patients: comparative results

Radiofrequency (RF) catheter ablation has been widely and successfully employed to cure adult and pediatric patients of a variety of arrhythmias. Only limited data exist which compare the results in these two groups. The aim of this study was to compare the efficacy and safety of RF catheter ablation in pediatric versus adult patients performed by an adult electrophysiology (EP) team.

The study group included 327 consecutive pediatric (n=47) and adult (n=280) patients, aged 7-82 years (mean 40+/-19), with symptomatic tachyarrhythmias, who underwent RF ablation during the last 6 years. All but ten patients underwent a full EP study during the same session. Procedures were performed in all but five patients with use of local anesthesia and deep or light sedation. The left heart was approached with use of transaortic (n=36) or transseptal (n=55) or both (n=6) techniques. RF ablation was performed for manifest or concealed accessory pathways in 132 patients, AV nodal slow pathway in 119, atrial tachycardia in 24, atrial flutter in 15, atrial fibrillation in one, ventricular tachycardia in 29, and AV node/His bundle in 7 patients.

RF ablation was successful in 271 (96.8%) patients in the adult group and in all patients (100%) in the pediatric group, with a mean of 15+/-18 (median: 8) vs 12+/-10 (median: 8) RF applications respectively (P=NS). Complications occurred in four patients (1.4%) in the adult group and in one patient (2.1%) in the pediatric group (P=NS). Fluoroscopy time averaged 43+/-40 min vs 39+/-27 min and procedures lasted for 3.0+/-1.9 hours vs 2.8+/-1.4 hours respectively (P=NS). During long-term follow-up of 25+/-19 months, there were 12 (4.4%) recurrences among the adult patients, and three (6.4%) recurrences in children, with nine of them successfully treated with repeat RF ablation. Procedural variables were dependent on the type of arrhythmia ablated, rather than on patient's age. Patients with multiple accessory pathways or atrial flutter required the greatest number of RF applications and the longest fluoroscopy exposure and duration of the procedure; the lowest values of these variables concerned ablation of the slow AV nodal pathway or the AV node/His bundle.

RF ablation in adult and pediatric patients performed by an adult EP team is equally efficacious and safe offering cure of symptomatic cardiac tachyarrhythmias in both patient populations.