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Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes
George F Van Hare1, Harold Javitz, Dorit Carmelli
1Department of Pediatrics, Division of Cardiology, Stanford University, Stanford, California 94304, USA. George.Van.Hare@Stanford.edu
Insights
Radiofrequency ablation in children with supraventricular tachycardia shows high success rates (95.7%) and low complication rates. This multicenter study establishes a benchmark for pediatric ablation outcomes.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Ablation
Background:
- Radiofrequency (RF) ablation is a key treatment for pediatric supraventricular tachycardia.
- Assessing outcomes in a large, multicenter pediatric cohort is crucial for establishing best practices.
Purpose of the Study:
- To evaluate the acute safety and efficacy of RF ablation in pediatric patients.
- To establish a benchmark for success rates and complication occurrence in pediatric RF ablation.
Main Methods:
- A multicenter prospective study and national registry were established.
- Patients aged 0-16 years with supraventricular tachycardia were included.
- Acute procedural results were analyzed across three patient groups.
Main Results:
- Overall RF ablation success rate was 95.7%.
- Higher success was noted for left-sided pathways (97.8%) compared to right (90.8%).
- Complication rates for electrophysiologic study and RF ablation were low (4.2% and 4.0%), with no deaths.
Conclusions:
- The study confirms high success and low complication rates for pediatric RF ablation.
- Results are comparable to previous single-center studies, validating their use as a benchmark.
- This data provides a current standard for expected outcomes in pediatric patients undergoing ablation.
Introduction:
A multicenter prospective study was designed and implemented to assess the short- and longer-term results and risks associated with radiofrequency (RF) ablation in children.
Methods And Results:
Patients recruited for the study were aged 0 to 16 years with supraventricular tachycardia due to accessory pathways or AV nodal reentrant tachycardia (AVNRT), excluding patients with nontrivial congenital heart disease. A national registry also was established, and contributing centers were encouraged to enroll all pediatric patients, aged 0 to 21 years, undergoing ablation at their center. This report summarizes acute results of these procedures. For analysis, subjects were divided into three groups: the prospective cohort (n = 481), cohort-eligible registry participants (n = 504), and not cohort eligible registry participants (n = 1,776). Prospectively enrolled cohort patients were similar to cohort-eligible patients in terms of demographic and other patient characteristics. Overall success rates for RF ablation were high (95.7%), with higher success rates for left-sided and particularly left free-wall pathways (97.8%) than right free-wall pathways (90.8%). Complications of both electrophysiologic study and RF ablation were infrequent (4.2% and 4.0%, respectively), and there were no deaths. AV block was uncommon overall (1.2%) and was limited to ablation in AVNRT (2.1%) and septal accessory pathways (3.0%).
Conclusion:
Despite the multicenter and prospective design, the study demonstrates high success rates and low complication rates, which are comparable to prior single-center retrospective studies. These results may serve as the current best benchmark for expected results in the pediatric population, aged 0 to 16 years, both in terms of acute success rates and the occurrence of complications.
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