Radiofrequency Ablation in Pediatric and Adult Patients: Comparative Results

  • Antonis S. Manolis
  • Vassilis Vassilikos
  • Themos N. Maounis
  • John Chiladakis
  • Dennis V. Cokkinos
Article

Abstract

Background: Radiofrequency (RF) catheter ablation has been widely and successfully employed to cure adult and pediatric patients of a variety of arrhythmias. Only limited data exist which compare the results in these two groups. The aim of this study was to compare the efficacy and safety of RF catheter ablation in pediatric versus adult patients performed by an adult electrophysiology (EP) team.

Methods: The study group included 327 consecutive pediatric (n=47) and adult (n=280) patients, aged 7–82 years (mean 40±19), with symptomatic tachyarrhythmias, who underwent RF ablation during the last 6 years. All but ten patients underwent a full EP study during the same session. Procedures were performed in all but five patients with use of local anesthesia and deep or light sedation. The left heart was approached with use of transaortic (n=36) or transseptal (n=55) or both (n=6) techniques. RF ablation was performed for manifest or concealed accessory pathways in 132 patients, AV nodal slow pathway in 119, atrial tachycardia in 24, atrial flutter in 15, atrial fibrillation in one, ventricular tachycardia in 29, and AV node/His bundle in 7 patients.

Results: RF ablation was successful in 271 (96.8%) patients in the adult group and in all patients (100%) in the pediatric group, with a mean of 15±18 (median: 8) vs 12±10 (median: 8) RF applications respectively (P=NS). Complications occurred in four patients (1.4%) in the adult group and in one patient (2.1%) in the pediatric group (P=NS). Fluoroscopy time averaged 43±40min vs 39±27min and procedures lasted for 3.0±1.9 hours vs 2.8±1.4 hours respectively (P=NS). During long-term follow-up of 25±19 months, there were 12 (4.4%) recurrences among the adult patients, and three (6.4%) recurrences in children, with nine of them successfully treated with repeat RF ablation. Procedural variables were dependent on the type of arrhythmia ablated, rather than on patient's age. Patients with multiple accessory pathways or atrial flutter required the greatest number of RF applications and the longest fluoroscopy exposure and duration of the procedure; the lowest values of these variables concerned ablation of the slow AV nodal pathway or the AV node/His bundle.

Conclusion: RF ablation in adult and pediatric patients performed by an adult EP team is equally efficacious and safe offering cure of symptomatic cardiac tachyarrhythmias in both patient populations.

radiofrequency ablation tachyarrhythmias pediatric patients accessory pathways atrioventricular nodal reentrant tachycardia atrial tachycardia ventricular tachycardia 

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References

  1. 1.
    Jackman WM, Wang X, Friday KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff-Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991;324:1605-1611.Google Scholar
  2. 2.
    Calkins H, Langberg JL, Sousa J, et al. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Circulation 1992;85:1337-1346.Google Scholar
  3. 3.
    Lesh MD, Van Hare GF, Schamp DJ, et al. Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: results in 100 consecutive patients. J Am Coll Cardiol 1992;19:1303-1309.Google Scholar
  4. 4.
    Jackman WM, Beckman KJ, McClelland JH, et al. Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow pathway conduction. N Engl J Med 1992;327:313-318.Google Scholar
  5. 5.
    Kay GN, Epstein AE, Dailey SM, Plumb VJ. Role of radiofrequency ablation in the management of supraventricular arrhythmias: experience in 760 consecutive patients. J Cardiovasc Electrophysiol 1993;4:371-389.Google Scholar
  6. 6.
    Scheinman MM. NASPE survey on catheter ablation. PACE 1995;18:1474-1478.Google Scholar
  7. 7.
    Manolis AS, Wang PJ, Estes NAM III. Radiofrequency catheter ablation for cardiac tachyarrhythmias. Ann Intern Med 1994;121:452-461.Google Scholar
  8. 8.
    Manolis AS, Wang PJ, Estes NAM III. Radiofrequency ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia: do arrhythmia recurrences correlate with persistent slow pathway conduction or site of successful ablation? Circulation 1994;90:2815-2819.Google Scholar
  9. 9.
    Manolis AS, Wang PJ, Estes NAM III. Radiofrequency ablation of atrial insertion of left-sided accessory pathways guided by the “W sign”. J Cardiovasc Electrophysiol 1995;6:1068-1076.Google Scholar
  10. 10.
    Van Hare GF, Lesh MD, Scheinman M, Langberg JJ. Percutaneous radiofrequency catheter ablation for supraventricular arrhythmias in children. J Am Coll Cardiol 1991;17:1613-1620.Google Scholar
  11. 11.
    Saul JP, Hulse JE, De W, et al. Catheter ablation of accessory atrioventricular pathways in young patients: use of long vascular sheaths, the transseptal approach and a retrograde left posterior parallel approach. J Am Coll Cardiol 1993;21:571-583.Google Scholar
  12. 12.
    Walsh EP, Saul JP, Hulse JE, et al. Transcatheter ablation of ectopic atrial tachycardia in young patients using radiofrequency current. Circulation 1992;86:1138-1146.Google Scholar
  13. 13.
    Klitzner TS, Wetzel GT, Saxon LA, Stevenson WG. Radiofrequency ablation: a new era in the treatment of pediatric arrhythmias. Am J Dis Child 1993;147:769-771.Google Scholar
  14. 14.
    Kugler JD, Danford DA, Deal BJ, et al. for the Pediatric Electrophysiology Society. Radiofrequency catheter ablation for tacyarrhythmias in children and adolescents. N Engl J Med 1994;330:1481-1487.Google Scholar
  15. 15.
    Dhala A, Bremner S, Deshpande S, et al. Efficacy and safety of atrioventricular nodal modification for atrioventricular nodal reentrant tachycardia in the pediatric population. Am Heart J 1994;128:903-907.Google Scholar
  16. 16.
    Van Hare GF, Witherel CL, Lesh MD. Follow-up of radiofrequency catheter ablation in children: results in 100 consecutive patients. J Am Coll Cardiol 1994;23:1651-1659.Google Scholar
  17. 17.
    Manolis AS, Vassilikos V, Maounis T, Chiladakis J, Cokkinos DV. Radiofrequency ablation in older children and adolescents by an adult electrophysiology team. J Interv Card Electrophysiol 1999;3:79-86.Google Scholar
  18. 18.
    Hindricks G, on behalf of the Multicenter European Radiofrequency Survey (MERFS) Investigators. Complications of radiofrequency catheter ablation of arrhythmias. Eur Heart J 1993;14:1644-1653.Google Scholar
  19. 19.
    Manolis AS, Wang PJ, Estes NAM III. Radiofrequency ablation of left-sided accessory pathways: transaortic versus transseptal approach. Am Heart J 1994;128:896-902.Google Scholar
  20. 20.
    Bubolz B, Case CL, McKay CA, O'Connor BK, Knick BJ, Gillette PG. Learning curve for radiofrequency catheter ablation in pediatrics at a single institution. Am Heart J 1996;131:956-960.Google Scholar
  21. 21.
    Danford DA, Kugler JD, Deal B, et al. The learning curve for radiofrequency ablation of tachyarrhythmias in pediatric patients. Am J Cardiol 1995;75:587-590.Google Scholar
  22. 22.
    Park JK, Halperin BD, McAnulty JH, Kron J, Silka MJ. Comparison of radio-frequency catheter ablation procedures in children, adolescents, and adults and the impact of accessory pathway location. Am J Cardiol 1994;74:786-789.Google Scholar
  23. 23.
    Tai C-T, Chen S-A, Chiang C-E, et al. Accessory atrioventricular pathways and atrioventricular nodal reentrant tachycardia in teenagers. Jpn Heart J 1995;36:305-317.Google Scholar
  24. 24.
    Manolis AS, Maounis T, Vassilikos V, et al. Pretreatment with antithrombotic agents during radiofrequency catheter ablation: a randomized comparison of aspirin versus ticlopidine. J Cardiovasc Electrophysiol 1998;9:1144-1151.Google Scholar
  25. 25.
    Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Am J Cardiol 1997;80:1438-1443.Google Scholar
  26. 26.
    Saul JP, Hulse JE, Papagiannis J, Van Praagh R, Walsh EP. Late enlargement of radiofrequency lesions in infant lambs: implications for ablation procedures in small children. Circulation 1994;90:492-499.Google Scholar
  27. 27.
    Manolis AS, Vassilikos V, Maounis T, et al. Detection of myocardial injury during radiofrequency catheter ablation by measuring serum cardiac troponin I levels: procedural correlates. J Am Coll Cardiol 1999;34:1099-1105.Google Scholar
  28. 28.
    Chiladakis JA, Vassilikos VP, Maounis TN, Cokkinos DV, Manolis AS. Successful radiofrequency catheter ablation of automatic atrial tachycardia with regression of the cardiomyopathy picture. PACE 1997;20(I):953-959.Google Scholar
  29. 29.
    Lindsay BD, Eichlins JO, Ambos HD, Cain ME. Radiation exposure to patients and medical personnel during radiofrequency catheter ablation for supraventricular tachycardia. Am J Cardiol 1992;70:218-223.Google Scholar
  30. 30.
    Geise RA, Peters NE, Dunnigan A, Milstein S. Radiation doses during pediatric radiofrequency catheter ablation procedures. PACE 1996;18(Pt. I):1605-1611.Google Scholar

Copyright information

© Kluwer Academic Publishers 2001

Authors and Affiliations

  • Antonis S. Manolis
    • 1
  • Vassilis Vassilikos
    • 1
  • Themos N. Maounis
    • 1
  • John Chiladakis
  • Dennis V. Cokkinos
    • 1
  1. 1.Cardiology DivisionPatras UniversityPatrasGreece

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