Can pediatric electrophysiologists safely perform electrophysiology studies on adults with congenital heart disease?

Adults with congenital heart disease (ACHD) are known to have arrhythmias. The purpose of this study was to review the safety and efficacy of a pediatric electrophysiologist performing electrophysiology studies (EPS) on ACHD.

All ACHD >18 years of age who underwent an EPS performed by a pediatric electrophysiologist between 1995 and 2004 were included. Patient records were reviewed for demographics, cardiac diagnosis, surgery, arrhythmia, and catheterization issues such as vascular access, fluoroscopy time, complications, procedure performed, and success rates.

The study identified 70 patients who underwent 93 EPS: 42 with ventricular tachycardia (VT) and 28 with supraventricular tachycardia (SVT). With respect to safety, vascular access was obtained in 100% of patients, fluoroscopy time averaged 34.2 minutes, and complications occurred in 3 patients (4%) including permanent (1) or transient (1) atrio-ventricular node injury and coagulum on the catheter (1), but no deaths. With respect to efficacy, 30 patients had an attempted radiofrequency ablation that was successful in 21 of 28 (75%) with SVT and 1 of 2 (50%) with VT.

(1) ACHD can safely undergo an electrophysiology study performed by pediatric electrophysiologists, with low fluoroscopy times and few complications. (2) Success rates for ablation in this patient population approach 75%.