Management of paediatric arrhythmias in Europe: authors' reply

Journal of Neonatal Biology, 2017

Introduction: Cardiac arrhythmias are challenging conditions in pediatric patients, especially in the case of newborns. Most of the tachyarrhythmias in children (90.24%) are atrioventricular reentrant tachycardias (AVRT) and atrioventricular nodal reentrant tachycardias (AVNRT). Although the standard 12-lead ECG maintains high diagnostic value, an invasive electrophysiological study with catheter ablation are often required. Unfortunately these procedures are burdened by the use of radiations. Materials and methods: We performed a systematic research in PubMed and Embase. We found 257 articles of interest but we selected only 36 as the most representative. Discussion: The main concerns linked to electrophysiological procedures are the need of fluoroscopy and thus the risk of malignancy as well as dermatitis, cataracts, thyroid diseases and birth defects in the patients' offspring. Children and especially newborns have a greater life expectancy so their cumulative risk is greater than adults. For this reason the guiding principle in electrophysiological procedures involving radiations in pediatric subjects is "as low as reasonably achievable" (acronym: ALARA). The development of 3-dimensional (3-D) electroanatomical mapping systems allowed a significant reduction of radiation exposure during catheter ablations. The most recent experiences demonstrated the feasibility and the safety of fluoroless ablation procedures of the most common arrhythmias in children. Conclusions: Cardiac arrhythmias could be very challenging conditions in pediatric patients. Predictors of complications are body weight <15 kg and age <4 years so it is clear that newborns are the most difficult patients. It is reasonable, because of these evidences, to approach cardiac arrhythmias pharmacologically in younger subjects. More than 20 years of experiences conducted by the electrophysiologists allow us to encourage the use of the electroanatomical mapping systems, with the objective of reducing the radiation exposure in children, especially when accessory pathways are involved.

OBJECTIVES We sought to describe the early pediatric experience of transcatheter cryoablation, and identify whether specific arrhythmia substrates and/or ablation locations were particularly suited to cryoablation. BACKGROUND Radiofrequency (RF) ablation has become established therapy for pediatric tachyarrhythmias. However, challenges remain in terms of the safety and efficacy of RF ablation in specific locations; new methods may address these issues. METHODS Prospective data were available for 64 patients age 13 4 (mean SD) years undergoing cryoablation at 14 centers participating in the Cryocath International Patient Registry. Dysrhythmia duration was 5.0 4.2 years, with diagnoses of atrioventricular node re-entrant tachycardia (AVNRT) (n 30), anteroseptal (n 11), midseptal (n 5), or other (n 15) accessory pathway (AP) mediated AV re-entry, ventricular tachycardia (VT) (n 3), and ectopic atrial tachycardia (EAT) (n 2). Two patients had more than one arrhythmia substrate. Transcatheter cryoablation was offered by cardiologist preference after written informed procedural consent of each patient and/or legal guardian. Cryomapping was performed at 30°C and cryoablation was delivered with 4-min applications at 75°C. RESULTS Acute success was achieved in 45 of 65 (69%) cryoablation patients, with best success rates in AVNRT (83%) and right septal AP (75%), and lower success rates in other AP (43%), VT (66%), and EAT (0%). No device-related adverse events were reported. The success of radiofrequency (RF) ablation applied in 14 cryoablation failures was 4 of 4 for AVNRT patients, 1 of 1 for anteroseptal AP patients, 5 of 6 for other AP patients, 0 of 1 for VT patients, and 0 of 2 for EAT patients. CONCLUSIONS Transcatheter cryoablation is a safe and well-tolerated alternative to RF ablation in pediatric patients on the basis of our initial experience. Success is highest in AVNRT and in substrates recognized as technically challenging or risky for RF ablation. (J Am Coll Cardiol 2005;45: 133– 6)

Journal of the American College of Cardiology, 2005

We sought to describe the early pediatric experience of transcatheter cryoablation, and identify whether specific arrhythmia substrates and/or ablation locations were particularly suited to cryoablation. BACKGROUND Radiofrequency (RF) ablation has become established therapy for pediatric tachyarrhythmias.

The Journal of Pediatrics, 1997

Objective: A review of the results of the first 5 years of radiofrequency catheter ablation procedures performed at Children's Hospital, Boston, a large tertiary referral center for patients with congenital heart disease and arrhythmias common to the infant, child, and young adult.

ACC Current Journal Review, 2005

Management of pediatric arrhythmias has evolved significantly over the years. Before 1990, management options were limited to pharmacological therapy or surgical treatment. Radiofrequency (RF) ablation for treatment of supraventricular tachycardia (SVT) in children was first introduced in 1989. Since then, ongoing technological advances in ablation and improved understanding of the arrhythmias have made transcatheter treatment the frontline treatment for various pediatric arrhythmias worldwide. Success rates for all pediatric arrhythmias reported by the pediatric RF catheter ablation (RFCA) registry have improved from 90% in the early era (1991)(1992)(1993)(1994)(1995) to 95% in the more recent era (1996 -1999).

Cureus, 2020

Background Arrhythmias are one of the reasons for emergency hospitalization among the pediatric population. Radiofrequency ablation is a major advancement in the management of children with cardiac arrhythmias. Objectives Our study was designed to describe the outcomes of catheter ablation in the pediatric population for atrial and ventricular arrhythmias in our center. Methods All patients between two and 18 years of age undergoing radiofrequency ablation after failed medical management for arrhythmias in our institute were included. Age less than two years, no previous medical management, and complex congenital heart disease were excluded. Baseline and electrophysiological characteristics were recorded. The patients were followed up for a clinical or electrocardiographic recurrence of arrhythmia. Results Thirty-six patients were included (mean age 12.8 ± 3.9 years (range 2-18 years), male 56%, average weight 36.39 ± 11.02 kg). The mean follow-up duration was 27.7 ± 15.9 months (range 3-58). Five-point five percent (5.5%) had tachycardiomyopathy. The arrhythmias included (1) atrioventricular nodal re-entrant tachycardia (AVNRT, n=16, 44%), (2) atrioventricular reciprocating tachycardia (AVRT, n=14, 39%), (3) atrial tachycardia (AT, n=2, 5.5%), (4) ventricular premature complexes (VPCs, n=2, 5.5%), (5) atrial flutter (AFL, n=1, 3%), and (6) ventricular tachycardia (VT, n=1, 3%). A transeptal puncture was done in 10 patients (28%). 3D mapping was done in six patients. The mean radiofrequency (RF) pulses were 2.3 ± 1.3. The acute procedural success rate was 100%. The long-term success was 97.2%. One (2.7%) developed recurrence. No major complications were reported. Conclusion Catheter ablation in the pediatric population is a safe procedure and can be done with more feasibility and fewer complications when done in experienced hands.

Iranian journal of pediatrics, 2012

Ablation techniques of cardiac arrhythmia in children have significantly progressed in the past decade; however, the number of pediatric ablations is still significantly lower than that in adults. Accordingly, there is less information regarding the success rate and complications in this age group. All pediatric ablations conducted between March 2005 and February 2011 at Rajaie Heart Center were studied. Abolishing the arrhythmia source by the end of procedure was considered as success. Recurrences before hospital discharge and those thereafter were named early recurrence and late recurrence, respectively. A total of 125 catheter ablations were performed for 112 patients. Of them 118 (94.4%) procedures were successful. The success rate was significantly higher in the patients with atrioventricular nodal reentry tachycardia (AVNRT). Of 105 patients who continued follow-up program, 7 (6.7%) cases experienced recurrence; the recurrence rate was inversely dependent on the patients&#39; ...

Europace, 2014

We aimed to evaluate long-term utilization and results of paediatric radiofrequency catheter ablation (RFCA) in a population-based study. Data from all three centres performing paediatric RFCA for the whole population of the Czech Republic between 1993 and 2010 were retrospectively reviewed. A total of 708 ablation procedures in 633 consecutive patients ,18 years for 716 different substrates were tracked, with accessory pathways ¼ 439 (61.3%) and atrioventricular nodal reentry tachycardia (AVNRT) ¼ 205 (28.6%) being most frequent. Incidence of RFCA reached 0.049 per 1000 children ,18 years of age in the recent era (2006-10). Indications included patient preference (68.0%), drug refractoriness (15.5%), asymptomatic Wolff-Parkinson -White pre-excitation (8.4%), and malignant arrhythmia (6.1%). Median follow-up was 13.7 (interquartile range 5.7-21.5) months. Overall acute/long-term success of the primary procedure was 89.1/77.2% (accessory pathways 87.2/77.7%, AVNRT 98.5/84.4%). Re-ablation was performed in 73 of 163 substrates after a primary unsuccessful ablation resulting in a long-term cumulative efficacy of 96.3%. Between 1993-2005 and 2006-10, procedure/fluoroscopy time decreased from median 154/24 to 105/14 min. (P , 0.001 for both). Serious complications occurred in nine patients (1.4%). This population-based study could replicate data from previous single-or multi-centre reports confirming RFCA as a safe method of arrhythmia treatment in children with long-term cumulative efficacy exceeding 90% and significant decrease in the procedure and fluoroscopy time during the study period. The need for RFCA can be estimated at 0.05/1000 children ,18 years using current indication criteria.

Congenital Heart Disease, 2012

Pacing and Clinical Electrophysiology, 2012

Background: Cryoablation (Cryo) has augmented radiofrequency (RF) as the ablation energy choice for most supraventricular tachycardias (SVT). Although initial acute results and more recent, but limited, 3-36-month follow-up studies have been reported, more longer follow-up information is required to determine actual efficacy.