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Surgical management of refractory supraventricular tachycardia in infants and children
Insights
Surgical correction effectively treated refractory supraventricular arrhythmias in children by targeting aberrant pathways. Refined techniques, including cryoablation, improved success rates for these complex pediatric heart rhythm disorders.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Interventional Cardiology
Background:
- Refractory supraventricular arrhythmias pose significant challenges in pediatric patients.
- Aberrant conduction pathways, such as Kent bundles, are common causes of these arrhythmias.
- Surgical intervention is considered for cases unresponsive to medical management.
Purpose of the Study:
- To evaluate the efficacy of surgical correction for refractory supraventricular arrhythmias in children.
- To assess the outcomes of intraoperative electrophysiologic mapping followed by surgical division or cryoablation.
- To analyze the types and locations of aberrant pathways and their impact on surgical success.
Main Methods:
- Sixty-seven children underwent attempted surgical correction.
- Intraoperative electrophysiologic mapping was used to identify aberrant conduction pathways or atrial ectopic foci.
- Surgical division or cryoablation was performed based on mapping findings.
Main Results:
- Eighty-two percent of patients had an abnormal conduction pathway (Kent bundle).
- Overall success rate was 85.5% (59 out of 67 patients), with 14.5% failure/recurrence rate.
- Recent technique refinements and cryoablation for septal pathways improved results to an 8% failure rate in the last 25 cases.
Conclusions:
- Surgical correction guided by electrophysiologic mapping is an effective treatment for refractory supraventricular arrhythmias in children.
- Cryoablation, particularly for septal pathways, has enhanced procedural success.
- Further refinements in surgical techniques continue to improve outcomes for pediatric arrhythmias.
Abstract:
Sixty-seven children underwent attempted surgical correction of refractory supraventricular arrhythmias using a combination of intraoperative electrophysiologic mapping followed by surgical division or cryoablation of an aberrant conduction pathway or atrial ectopic focus. The patients ranged in age from 4 months to 18 years (mean 11.4 years). Fifty-five patients (82%) had an abnormal conduction pathway crossing the atrioventricular junction (Kent bundle). Thirty-six (65%) of these 55 patients had classic Wolff-Parkinson-White syndrome with a delta wave of pre-excitation on the surface electrocardiogram. Nineteen (35%), however, demonstrated only retrograde conduction across the Kent bundle and had a normal surface electrocardiogram when tachycardia was not present. Kent bundles were isolated to the following locations: right anterior or lateral in 19 (34.5%), left posterior or lateral in 22 (40%), posteroseptal in 10 (18%), anteroseptal in 2 (4%) and both right and left in 2 (4%). Follow-up evaluation of as long as 8 years (mean 34.9 months) has shown seven immediate failures and one late recurrence of arrhythmia (14.5%). Recent refinements in technique and the use of cryoablation for septal aberrant pathways have improved these results. There have been two failures (8%) in the last 25 attempts. Twelve patients underwent surgery for an atrial ectopic focus by the following techniques: cryoablation in seven patients, excision in one patient and both excision and cryoablation in four patients. At a mean follow-up of 16.6 months, there was one late recurrence in the group with an atrial ectopic focus.(ABSTRACT TRUNCATED AT 250 WORDS)