Radiofrequency Modification for Inducible and Suspected Pediatric Atrioventricular Nodal Reentry Tachycardia

Abstract

AV Node Reentry Tachycardia (AVNRT) is the second most common supraventricular tachycardia (SVT) undergoing pediatric radiofrequency ablation behind accessory pathway reentry tachycardias. AVNRT can be difficult to induce during electrophysiology study (EPS) and dual atrioventricular nodal (AVN) pathways physiology may not be demonstrated in young patients. This report is the largest single center long term pediatric experience of radiofrequency modification of slow AVN input fibers for inducible or suspected (non-inducible) AVNRT. One hundred thirty-two patients underwent slow input AVN modification from 1993 to 2002. The mean patient age was 13.7 years (4-20 yrs) with 62M/70F. Outpatient tachycardia was documented by ambulatory monitoring in all patients. AVNRT was induced in 98/132 patients during EPS (group A) with mean SVT cycle length of 324 msec (230-570 msec). Initial AVN modification (group A) was successful in 97/98 patients (99%). During 34/132 EPS, AVNRT was non-inducible; dual AVN physiology was present in 19/34 (group B), and 15/34 did not show evidence for dual AVN physiology (group C). These 34 patients underwent empiric AVN modification following discussion with patients' families. Freedom of recurrence from SVT at 1 year was 96% for group A (94/98), 89% (17/19) for group B and 93% (14/15) for group C. 1 major and 6 minor complications occurred. AVN modification for AVNRT can be performed safely and effectively in pediatric patients with good long-term results. Empiric slow pathway AVN modification for non-inducible SVT results in a high rate of freedom from recurrence of tachycardia.