308 Are there indications for supraventricular re-entrant tachycardia in the youth?

Abstract

Radiofrequency (RF) ablation of paroxysmal supraventricular tachycardia (SVT) that could be an atrioventricular node re-entrant tachycardia (AVNRT) or AV reentrant tachycardia (AVRT) through a concealed accessory pathway (AP) is widely used in adults, but the indications remain controversed in children and teenagers. The purpose of the study was to evaluate the clinical and electrophysiological factors of indications of AVNRT and AVRT ablation in the youth and the results of the procedure. 66 children or teenagers aged from 6 to 18 years (15 ± 2) among 1099 patients consecutively recruited for SVT; they had a normal ECG in sinus rhythm; AVNRT or AVRT was confirmed at electrophysiological study (EPS). Patients with anterograde conduction through an AP were excluded. RF ablation was indicated in 26 children or teenagers (39%) (group I) significantly less frequently than in adults (668/1033; 65%) (p < 0.0000). 40 other children were not treated or received beta blockers (group II). Group I and II have the same age (15 ± 2.6 vs 15 ± 2.8). Male gender tended to be less frequent in group I (9/26; 35%) than in group II (20/40; 50%) (NS, 0.2). At EPS, group I had more frequently a concealed AP (13/26; 50%) than group II (8/40; 20%) (p < 0.01). The incidence of concealed AP in group I is higher than in adults (102 of 668 procedures;15%) (p < 000000). In remaining children, ablation of slow pathway was performed in 13 children. There were no complications, but failures or reappearances of SVT after ablation were frequent (6/26; 23%), more frequent in AVRT (4/13) than in AVNRT (2/13) (NS) and were related to the age (12.7 ± 3 vs 16 ± 2; p < 0.002). They tended to be more frequent than in adults (77/668; 11.5%) (p < 0.07). In group II, 3 children continue the beta blockers and other children are not treated. The indications of slow pathway remain rare in children. Most of the indications of SVT ablation in the youth which are rare, concern generally the children and teenagers with concealed AP. The results are almost as good as in adults, mainly for the slow pathway ablation and in teenagers.