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[Use of transesophageal pacing for documentation of older children with accessory pathway]
1Unité de rythmologie pédiatrique, Château-des-Côtes, 78350 Les-Loges-en-Josas, France. vincent.lucet@centredescotes.com
Insights
Transesophageal electrophysiology is a valuable tool for evaluating accessory pathways in children, guiding ablation decisions for those with overt preexcitation. This method helps manage risks of sudden cardiac death in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Cardiac Arrhythmias
Background:
- Accessory pathways in children pose risks of severe cardiac events, including sudden death.
- Radiofrequency ablation is a standard treatment, but potential complications necessitate careful evaluation.
- Transesophageal electrophysiologic study offers a method for assessing accessory pathways.
Purpose of the Study:
- To evaluate the utility of transesophageal electrophysiologic study for accessory pathway assessment in children.
- To determine the role of this technique in guiding radiofrequency ablation decisions.
- To compare its effectiveness in symptomatic versus asymptomatic pediatric patients.
Main Methods:
- Retrospective analysis of 140 procedures over 19 years, focusing on 70 accessory pathway evaluations.
- Study population included 59 children older than 5 years with overt preexcitation.
- Transesophageal electrophysiologic study was used to determine anterograde refractory periods.
Main Results:
- Anterograde refractory periods were determined in 88% of cases.
- Refractory periods <220 ms in 12 cases indicated ablation.
- Longer refractory periods (>250 ms) led to non-ablation in 8 asymptomatic and postponed ablation in 11/20 mildly symptomatic children.
Conclusions:
- Transesophageal electrophysiologic study is effective for asymptomatic or mildly symptomatic children with accessory pathways.
- The technique may be less beneficial for overt preexcitation with recurrent tachycardia requiring antiarrhythmic drugs.
- Endocavitary electrophysiological study followed by ablation is preferred for complex cases.
Introduction:
In case of an accessory pathway, children are exposed to severe cardiac events including sudden death. Radiofrequency ablation is a standardized procedure, which can be applied to a significant number of children although complications can still potentially occur. In this context, transesophageal evaluation of the accessory pathway evaluation can be discussed.
Materials And Methods:
Among 140 procedures performed in 19 years, 70 were done for accessory pathway evaluation. The preexcitation was overt in 59 children older than 5 years, which form the basis in this study.
Results:
Anterograde refractory period was determined in 88% cases and was found<220 ms in 12 cases justifying an ablation procedure. Conversely, in case of a long refractory period (>250 ms), the ablation procedure was not performed in 8 asymptomatic cases and was postponed in 11/20 mildly symptomatic children. Transesophageal electrophysiologic study seems legitimate in asymptomatic or mildly symptomatic children.
Conclusion:
This technique is probably less useful in case of an overt preexcitation and recurrent reciprocating tachycardia requiring long-term antiarrythmic treatment. In this case, endocavitary electrophysiological study eventually followed by an ablation procedure seems the best option.
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