TWENTY YEARS OF PEDIATRIC CATHETER ABLATION: EVOLUTION OF PRACTICE
J.M. Côté, F. Philippon, J. Champagne, M. Gilbert, F. Molin, L. Blier, I. Nault, J.F. Sarrazin, P. Chetaille, G. O'Hara
Department of Cardiology, IUCPQ, Quebec, Canada
Introduction: The Quebec Heart and Lung Institute serves more than 2 million people and represents the only electrophysiologic (EP) center for both children and adults in this population. The purpose of this study was to evaluate our experience with catheter ablation in children over a 20-year period.
Results: From 1993 to 2013, 649 EP procedures (85% with ablation) were performed in 591 children with a mean age of 13.3±3.6 years (range 9 months to 17.9 years). Catheter ablation of all AVNRT (n=179) was performed using radiofrequency with recurrence in only 4 patients and no permanent AV block. Concealed or manifest accessory pathways (PW) were documented in 289 procedures.
Recently, in selected postero-septal PW, irrigated catheters have decreased recurrences and failed procedures. There were no major complications including death, AV block, stroke, and tamponade over the whole 20-year period.
Conclusions: Catheter ablation has dramatically improved the natural history of arrhythmia in children as long-term elimination of arrhythmia is obtained in most. New technologies (irrigated catheters, cryotherapy, 3D mapping) have provided additional safety and efficacy to septal pathways and flutter ablation.
Baseline characteristics for subjects with vs. without ER.
Type
|
N Patients
|
N Procedures
|
Age = 10 years
|
Long-Term Success
|
AVNRT |
176 |
179 |
10% |
99.5% |
Left PW |
162 |
175 |
21% |
99% |
Female (%) |
32 |
58 |
<0.001 |
<0.001 |
Right PW
- Postero-septal (PS)
- Antero-septal (AS)
- Non-septal
|
95
38
22
35
|
114
42
30
42
|
27%
19%
33%
26%
|
82%
100%
33%*
94%
|
PJRT |
22 |
27 |
67% |
100% |
Atrial Flutter |
12 (CHD = 8) |
15 |
67% |
8/8 (100%) CHD** |
Atrial Tachycardia |
22 |
27 |
18.5% |
90% |
Ventricular Tachycardia |
15 |
21 |
13% |
77% |
Hispanics (n,%) |
975 (0.1 |
68,342 (99.9) |
<0.001 |
<0.001 |
*Ablation attempted by cryotherapy in 12/22 patients. Acute success was achieved in 75%, with a recurrence rate of 44%.
**Congenital heart disease with ablation using a 3D mapping system.