Radiofrequency catheter ablation therapy used in 123 children with drug-refractory tachycardia arrhythmias

Abstract

Objective To evaluate the safety and efficacy of radiofrequency catheter ablation (RFCA) in children with tachycardia arrhythmias. Methods One hundred and twenty-three children under 3 years old with drug-refractory tachycardia underwent an interventional electrophysiology procedure and RFCA in Medical Center of Tsinghua University from April 1994 to December 2014, including 98 male and 25 female, and their average age was (22.9±9.6) months(2-35 months) and body weight was (13.64±2.80) kg(4.66-19.40 kg). The mechanism, RFCA methods, the success rate, recurrence rate and complication rate of the different types of tachycardia were investigated. Results Among these children, interventional electrophysiological study confirmed 94 cases (76.4%, 94/123 cases) with atrioventricular reentrant tachycardia (AVRT), 7 cases(5.7%, 7/123 cases) with atrioventricular nodal reentrant tachycardia (AVNRT), 3 cases (2.4%, 3/123 cases) with focal atrial tachycardia (FAT), 8 cases (6.5%, 8/123 cases) with atrial flutter (AF), 5 cases (4.1%, 5/123 cases) with idiopathic left ventricular tachycardia (ILVT), 6 cases (4.8%, 6/123 cases) arrhythmia was not induced.RFCA was performed in 109 cases (88.6%, 109/123 cases). The success rate of RFCA was 94.5%(103/109 cases) and the recurrence rate was 6.8% (7/103 cases). In 88 cases of AVRT, the success rate was 96.6%(85/88 cases), and the recurrence rate was 8.2%(7/85 cases). In 5 cases of AVNRT, the success rate was 100.0%(5/5 cases). In 3 cases of FAT, the success rate was 33.3%(1/3 cases). In 8 cases of AF, the success rate was 87.5%(7/8 cases). In 5 cases of ILVT, the success rate was 100.0%(5/5 cases), and there was no recurrence.The complication of RFCA was puncture vascular occlusion in 2 cases (1.6%, 2/123 cases), without other serious complications and death cases.In this group of children, the fluoroscopy exposure time was (11.2±5.8) min(5.7-18.2 min) and dose area product(DAP) exposure was (954.5±117.4) mGy×cm2(707-2 201 mGy×cm2). Compared with the elder children (379 cases over 3 years old) of the exposure fluoroscopy time(10.8±6.4) min(3.9-20.5 min) and DAP exposure (927.5±193.4) mGy×cm2(439-3 201 mGy×cm2), there was no statistically significant difference(t=0.616, 1.463, all P>0.05). Conclusions AVRT was the most common type of arrhythmia in infants and a higher incidence of multiple accessory pathways was found in infants.Application of radiofrequency ablation to children with tachycardia arrhythmias can be relatively safe and effective to the infants with drug-resistant tachycardia. Key words: Tachycardia arrhythmia; Radiofrequency catheter ablation; Infant