Utility of Echocardiography in Detecting Silent Complications After Pediatric Catheter Ablations
Although transcatheter arrhythmia ablation (TCA) has been performed in children for over two decades, guidelines for routine use of post-ablation transthoracic echocardiography (TTE) are absent. We sought to determine the efficacy of TTE after apparently uneventful TCA procedures in detecting adverse findings and identify predisposing factors. A retrospective review of clinical and procedural data on patients who underwent TCA for supraventricular arrhythmias from 2000 to 2015 was performed. Pre- and post-ablation TTE data were reviewed. All patients were followed at 1 week, 6 and 12 months post-TCA. A repeat TTE was performed at 12 months on patients in whom post-TCA abnormalities were found. Patients were divided into two groups: those with and without adverse TTE findings and comparative analysis between variables was performed. Data on 252 patients, 52% males, mean age 14 ± 3 years were analyzed. New onset or worsening atrioventricular valve regurgitation occurred in 17 (6.7%), a small pericardial effusion in 3 (1.2%) and worsened ventricular function in 2 patients (0.8%). Patients in the complication group had higher mean number of ablations (22.6 ± 15.3 vs. 16.8 ± 9.2, p 0.001) and required longer duration of ablation (sec) (254.6 ± 256.4 vs. 180.9 ± 158.9, p < 0.001). TCA location (including coronary sinus), energy source, arrhythmia substrate, and a trans-septal approach were noncontributory to any adverse findings. Routine post-ablation TTE uncovers asymptomatic self-resolving abnormalities that typically do not require any intervention.
KeywordsEchocardiogram Supraventricular tachycardia (SVT) Atrioventricular reentrant tachycardia (AVRT) Atrioventricular nodal reentrant tachycardia (AVNRT) Radiofrequency ablation Cryoablation Pericardial effusion Valvular regurgitation Ventricular function
Dr. Shahnawaz Amdani and Dr. Sanjeev Aggarwal conceptualized and designed the study, carried out the analysis, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Salaam Sallaam carried out the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. Dr. Peter Karpawich drafted the initial manuscript, reviewed and revised the manuscript, and approved the final manuscript as submitted.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with Ethical Standards
Conflicts of interest
The authors have no conflicts of interest to disclose.
- 8.Co-Chairs TF (2016) PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 13(6):e252Google Scholar
- 9.Van Hare GF, Colan SD, Javitz H, Carmelli D, Knilans T, Schaffer M, Kugler J, Byrum CJ, Saul JP (2007) participating members of the pediatric electrophysiology society. prospective assessment after pediatric cardiac ablation: fate of intracardiac structure and function, as assessed by serial echocardiography. Am Heart J 153(5):815–820CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B et al (2013) American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 26(9):965–1012CrossRefPubMedGoogle Scholar
- 16.Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802CrossRefPubMedGoogle Scholar