Radiofrequency Current for Catheter Ablation of Accessory Atrioventricular Connections in Children and Adolescents. Emphasis on the Single-Catheter Technique

Abstract

Catheter ablation of an accessory atrioventricular connection using 500-kHz radiofrequency current was attempted in 10 children and adolescents aged between 6 and 15 years (mean 10.5 years). Six children had the Wolff-Parkinson-White syndrome and four had tachyarrhythmias related to a retrograde-only conducting ("concealed") accessory connection. No child had associated structural heart disease. Symptoms ranged from disabling palpitations to episodes of syncope (three patients) and cardiac arrest (one patient). Ablation was attempted from the left ventricle in all children; in one child, ablation of a second, right-sided pathway was attempted via a right atrial approach. Ten of the 11 accessory connections were interrupted successfully. A single complication was encountered in a 10-year-old girl in whom the procedure had to be terminated because a thrombotic occlusion of the right internal iliac artery had evolved. A simplification of the ablation procedure associated with reduced procedure duration and radiation exposure time was achieved in three children with the Wolff-Parkinson-White syndrome and a left free-wall accessory pathway when a single catheter placed in the left ventricle was used for pathway localization as well as ablation. It is concluded that catheter ablation using radiofrequency current is effective and safe and may supersede surgery as the curative treatment for children with serious symptoms mediated by an accessory atrioventricular connection.