Computer-guided surgery for tachyarrhythmias in children: current results and expectations

The purpose of this report is to summarize our entire surgical experience in the treatment of tachyarrhythmias in children. We emphasize our application of a newer computerized mapping system for use in both the electrophysiology laboratory and the operating room to localize points of activation of the tachyarrhythmias.

A retrospective review was undertaken to examine the results of operative procedures in 290 children undergoing surgical treatment for tachyarrhythmias from 1977 to the present.

Operative procedures were performed in 290 children and consisted of the following: surgical ablation of accessory pathways of the Kent bundle type (210 children); surgery with cryoablation for atrial ectopic tachycardia (35 children); surgical excision or cryoablation, or both, for ventricular tachycardia (26 children); cryoablation for the permanent form of junctional reciprocating tachycardia (15 children) and atrioventricular (AV) node reentrant tachycardia (4 children).

The surgical cure rate for accessory pathway tachycardia in the era before computerized mapping was 80% (41 patients) in the period from 1977 to 1982 and 95% (86 patients) in the period from 1982 to 1988. This rate improved to 100% (83 patients) after the advent of the computerized mapping technique. These improved results are probably due to a combination of factors, including increasing experience in electrophysiologic mapping and surgery, and cannot be attributed to the computerized mapping system alone. Surgical cure or major improvement in symptoms was documented in 33 (94%) of 35 patients with atrial ectopic tachycardia. Surgical cure was accomplished in 25 (96%) of 26 patients with the complex form of ventricular tachycardia. In 19 patients with the permanent form of junctional reciprocating tachycardia and the more typical AV node reentrant tachycardia, the surgical cure rate was 100%.

In all forms of supraventricular reentrant tachycardia that occur in children, preoperative computerized mapping techniques combined with intraoperative computerized mapping and surgical ablation can eliminate tachycardia at a success rate of close to 100%. Computerized mapping techniques are less accurate in patients with atrial ectopic tachycardia because of multiple foci and a broader surface area to be mapped. This experience demonstrates that excellent results can be achieved in the surgical treatment of tachyarrhythmias in children.