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Radiofrequency catheter ablation of accessory pathways in infants
Insights
Radiofrequency catheter ablation is a safe and effective treatment for supraventricular tachycardia in infants. This procedure successfully treated accessory pathways in all five infants, leading to symptom-free outcomes post-ablation.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Interventional Cardiology
Background:
- Supraventricular tachycardia (SVT) in infants can be life-threatening.
- Accessory atrioventricular pathways are a common cause of SVT in this population.
- Catheter ablation offers a potential curative treatment option.
Purpose of the Study:
- To assess the safety and efficacy of radiofrequency catheter ablation for SVT in infants.
- To identify indications, outcomes, and complications of the procedure in this age group.
Main Methods:
- Five infants under 9 months with SVT underwent radiofrequency catheter ablation.
- Ablation was performed for various indications including refractory tachyarrhythmia, aborted sudden death, ventricular dysfunction, and drug failure.
- Different transcatheter approaches were utilized based on pathway location, using a 5F bipolar electrode catheter.
Main Results:
- All five patients underwent a single, successful ablation procedure.
- Two procedures showed impedance changes suggesting coagulum formation.
- One patient experienced a transient ischemic complication; two patients developed mild to moderate pericardial effusion.
- At a mean follow-up of 18.4 months, all patients remained symptom-free without antiarrhythmic treatment.
Conclusions:
- Radiofrequency catheter ablation is a successful and viable treatment for infants with SVT due to accessory pathways.
- Implementing temperature monitoring in ablation catheters may help prevent coagulum formation.
- Post-ablation echocardiography is recommended to screen for pericardial effusion.
Objective:
To evaluate the indications, results and complications of radiofrequency catheter ablation in small infants with supraventricular tachycardia due to an accessory atrioventricular pathway.
Methods:
Five infants less than 9 months old underwent radiofrequency catheter ablation of accessory pathways. Ablation was done for medically refractory tachyarrhythmia associated with aborted sudden death in two patients, left ventricular dysfunction in one, failure of antiarrhythmic drugs in one, and planned cardiac surgery in one. All five patients underwent a single successful procedure. Three left free wall pathways were ablated by transseptal approach, a right posteroseptal pathway was ablated from the inferior vena cava, and a left posteroseptal pathway was approached from the inferior vena cava into the coronary sinus. A deflectable 5F bipolar electrode catheter with a 3 mm tip was used.
Results:
A sudden increment in impedance indicative of coagulum formation was observed in two procedures. One patient developed a transient ischaemic complication after ablation of a left lateral accessory pathway by transseptal approach. This patient had mild pericardial effusion after the procedure. Moderate pericardial effusion was also noted in another patient. After a mean follow up of 18.4 months all patients are symptom free without treatment.
Conclusions:
Radiofrequency catheter ablation can be performed successfully in infants. Temperature monitoring in 5F ablation catheters would be desirable to prevent the development of coagulum. Echocardiography must be performed after the ablation procedure to investigate pericardial effusion.