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Surgical management of dysrhythmias in infants and small children
F A Crawford1, P C Gillette, C L Case
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston 29425.
Insights
Surgical ablation is highly effective for treating serious heart rhythm problems in young children when other methods fail. This study shows a 94.5% success rate with no deaths, offering a safe option for pediatric cardiac dysrhythmias.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Pediatric Cardiac Surgery
Background:
- Cardiac dysrhythmias are less commonly surgically treated in pediatric populations compared to adults.
- Surgical intervention is considered for refractory or life-threatening arrhythmias in infants and children.
Purpose of the Study:
- To evaluate the efficacy and safety of surgical ablation for various cardiac dysrhythmias in infants and small children.
- To compare surgical outcomes with emerging catheter ablation techniques in this age group.
Main Methods:
- Retrospective review of 55 infants and children (≤5 years) undergoing surgery for arrhythmias between 1984 and 1991.
- Conditions treated included Wolff-Parkinson-White Syndrome, atrioventricular node reentry, atrial automatic tachycardia, and ventricular tachycardia.
- Outcomes assessed included success rates, mortality, morbidity, and ventricular function recovery.
Main Results:
- Overall surgical success rate was 94.5% (52/55 patients).
- Specific success rates: Wolff-Parkinson-White Syndrome (93%), atrioventricular node reentry (100%), atrial automatic tachycardia (100%), and ventricular tachycardia (100%).
- No hospital or late deaths; one patient had perioperative central nervous system injury. Ventricular function normalized in all 12 patients with pre-operative dysfunction.
Conclusions:
- Surgical ablation is a highly successful and safe treatment for refractory or life-threatening pediatric cardiac dysrhythmias.
- Surgery remains a viable and effective option, particularly given the challenges and limited long-term data of catheter ablation in infants.
- This approach offers significant benefits for managing complex arrhythmias in young children.
Abstract:
Surgery for cardiac dysrhythmias is infrequently reported in infants and children as compared with adults. This report reviews 55 infants and small children (age, less than or equal to 5 years) operated on during the interval July 1, 1984 to December 31, 1991 for Wolff-Parkinson-White Syndrome (41), atrioventricular node reentry (two), atrial automatic tachycardia (two), and ventricular tachycardia (nine). Ages ranged from 3 weeks to 71 (mean, 29) months. Associated congenital heart defects were present in five (10%). Indications for surgery included failure of medical therapy, life-threatening dysrhythmias, and more recently, failure of catheter ablation. There were no hospital or late deaths. One patient sustained perioperative central nervous system injury. Surgery was successful in 52 of 55 (94.5%) (Wolff-Parkinson-White, 38/41 (93%); atrioventricular node reentry, 2/2 (100%); atrial automatic tachycardia, 3/3 (100%); ventricular tachycardia, 9/9 (100%). Ventricular function returned to normal in all 12 patients in whom it was abnormal before operation. Thus, surgical ablation is highly successful in the management of various forms of refractory or life-threatening dysrhythmias in infants and small children. Catheter ablation techniques require significant fluoroscopic time, are more difficult in infants, and as yet do not have adequate long-term follow-up. Accordingly, surgery may continue to play a role in this particular group of patients.