Catheter Ablation of Tachyarrhythmias in Small Children

Blaufox, Andrew D. (2005) Catheter Ablation of Tachyarrhythmias in Small Children. [Journal (Paginated)]

Full text available as:



An estimated 80,000-100,000 radiofrequency ablation (RFA) procedures are performed in the United States each year.1 Approximately 1% of these are performed on pediatric patients at centers that contribute data to the Pediatric Radiofrequency Registry.2 Previous reports from this registry have demonstrated that RFA can safely and effectively be performed in pediatric patients.3,4 However, patients weighing less than 15 kg have been identified as being at greater risk for complications.3,4 Consequently, there has been great reluctance to perform RFA in small children such that children weighing less than 15 kg only represent approximately 6% of the pediatric RFA experience2 despite the fact that this age group carries the highest incidence of tachycardia, particularly supraventricular tachycardia (SVT).5 Factors other than the risk of complications contribute to the lower incidence of RFA in this group, including the natural history of the most common tachycardias (SVT), technical issues with RFA in small hearts, and the potential unknown long-term effects of RF applications in the maturing myocardium. Conversely, there are several reasons why ablation may be desirable in small children, including greater difficulties with medical management,6,7,8 the higher risk for hemodynamic compromise during tachycardia in infants with congenital heart disease (CHD), and the inability of these small children to effectively communicate their symptoms thereby making it more likely that their symptoms may go unnoticed until the children become more seriously ill. Before ultimately deciding that catheter ablation is indicated in small children, one must consider which tachycardias are likely to be ablated, the clinical presentation of these tachycardias, alternatives to ablation, the relative potential for success or complications, and modifications of the procedure that might reduce the risk of ablation in this group.

Item Type:Journal (Paginated)
Keywords:catheter ablation; cardiac arrhythmia; children
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4174
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:14 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

Select the SEEK icon to attempt to find the referenced article. If it does not appear to be in cogprints you will be forwarded to the paracite service. Poorly formated references will probably not work.

1. Huang SKS, Wilber DJ. Preface. In: Huang SKS, Wilber DJ, editors. Radiofrequency Catheter Ablation of Cardiac Arrhythmias: Basic Concepts and Clinical Applications. 2 ed. Armonk: Futura Publishing Company, Inc; 2000.

2. Blaufox AD, Felix G, Saul JP. Radiofrequency Catheter Ablation in Infants < 18 Months Old: When is it Done and How Do They Fare? Short-Term Data From the Pediatric Ablation Registry. Circulation 2001;104:2803-8.

3. Kugler JD, Danford DA, Deal BJ, Gillette PC, Perry JC, Silka MJ, Van Hare GF, Walsh EP. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. New England Journal of Medicine 1994;330(21):1481-7.

4. Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997;80:1438-43.

5. Perry JC, Garson A, Jr. Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence [see comments]. Journal of the American College of Cardiology 1990;16(5):1215-20.

6. Deal BJ, Keane JF, Gillette PC, Garson A, Jr. Wolff-Parkinson-White syndrome and supraventricular tachycardia during infancy: management and follow-up. Journal of the American College of Cardiology 1985;5(1):130-5.

7. Giardina AC, Ehlers KH, Engle MA. Wolff-Parkinson-White syndrome in infants and children. A long- term follow-up study. British Heart Journal 1972;34(8):839-46.

8. Garson A, Jr., Gillette PC, McNamara DG. Supraventricular tachycardia in children: Clinical features, response to treatment, and long-term follow-up in 217 patients. J.Pediatr. 1981;98:875-82.

9. Ko JK, Deal BJ, Strasburger JF, Benson DW, Jr. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. American Journal of Cardiology 1992;69(12):1028-32.

10. Mantakas ME, McCue CM, Miller WW. Natural history of Wolff-Parkinson-White syndrome in infants and children: a review and a report of 28 cases. Am J Cardiol 1978;41:1097-103.

11. Blaufox AD, Paul T, Saul JP. Radiofrequency Catheter Ablation in Small Chhildren: Relationship of Complications to Application Dose. PACE 2004;27:224-229.

12. Naik AM, Lokhandwala YY, Nabar AA, Dalvi BV. Catastrophic WPW syndrome in a 13-month child: cure by radiofrequency ablation. Indian Pediatr. 1997 Oct;34(10):931-7.

13. Klein GJ, Bashere TM, Sellers TD. Ventricular fibrillation in the Wolff-Parkinson-White syndrome. NEJM 1979;301:1080-5.

14. Klein GJ, Prystowsky EN, Yee R et al. Asymptomatic WPW. Should we intervene? Circulation 1989;80:1902-1905.

15. Kugler JD. Indications for Catheter Ablation in Infants and Children. Ch 21 in Cardiac Arrhythmias in Children and Young Adults with Congenital Heart Disease Walsh EP, Saul JP, and Triedman JK (Eds.) Lippincott Williams and Wilkins, Philadelphia, 2001.

16. Paul T, Guccione P, Garson A, Jr. Relation of syncope in young patients with Wolff-Parkinson-White syndrome to rapid ventricular response during atrial fibrillation. American.Journal.of.Cardiology 1990;65(5):318-21.

17. Benson DW, Jr., Dunnigan A, Benditt DG, Thompson TR, Narayan A, Boros S. Prediction of digoxin treatment failure in infants with supraventricular tachycardia: role of transesophageal pacing. Pediatrics 1985;75(2):288-93.

18. Weindling SN, Saul JP, Walsh EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. American Heart Journal 1996;131(1):66-72.

19. Danford Da, Kugler JD, and Deal B, etal. The learning curve for radiofrequency ablation of tachyarrhythmias in pediatric patients. Am J Cardiol. Vol. 75, 1995.

20. Kearney DL, Titus JL. Cardiovascular Anatomy. In: Garson AJ, Bricker JT, Fisher DJ, et al., editors. The Science and Practice of Pediatric Cardiology. second ed. Baltimore: Williams & Wilkins; 1998. p. 127-54.

21. Avitall B, Helms RW. Determinants of radiofrequency-induced lesion size. In: Huang SKS, Wilber DJ, editors. Radiofrequency Catheter Ablation of Cardiac Arrhythmias. Armonk, NY: Futura; 2000. p. 47-80.

22. Saul JP, Hulse JE, Papagiannis J, Van Praagh R, Walsh EP. Late enlargement of radiofrequency lesions in infant lambs. Implications for ablation procedures in small children. Circulation 1994;90(1):492-9.

23. Schaffer MS, Gow RM, Moak JP, Saul JP, Participating Members of the Pediatric Electrophysiology Society. Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry). Am J Cardiol 2000;86:639-43.

24. Goldberg CS, Caplan MJ, Heidelberger KP, and Dick M. The Dimensions of the Triangle of Koch in Children. Am J Cardiol 1999;83:117-120.

25. Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang, SK, Liem LB, Klein LS, et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group [see comments]. Circulation 1999 Jan;99(2):262-70.

26. Pons M, Beck L, Leclercq JF, Ferriere M, Albat B, Davy JM. Chronic Left Main Coronary Artery Occlusion: A Complication of Radiofrequency Ablation of Idiopathic Left Ventricular tachycardia. PACE 1997;20:1874-6.

27. Blaufox AD and Saul JP. Acute Coronary Artery Stenosis During Slow Pathway Ablation for Atrioventricular Nodal Reentrant Tachycardia in A Child. J Cardiovasc Electrophysiol 2004;15:97-100.

28. Paul T, Bokenkamp R, Mahnert B, Trappe HJ. Coronary artery involvement early and late after radiofrequency current application in young pigs. American Heart Journal 1997 Apr;133(4):436-40.

29. Bokenkamp R, Wibblet g, Sturm M, Windhagen-Mahnert B, Bertram H, Hausdorf G, Paul T. Effects of Intracardiac Radiofrequency Current Application on Coronary Artery Vessels in Young Pigs. J Cardiovasc Electrophysiol 2000;11:565-71.

30. Calkins H, Langberg J, Sousa J, el-Atassi R, Leon A, Kou W, Kalbfleisch S, Morady F. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome. Circulation 1992;85(4):1337-46.

31. Solomon AJ, Tracy CM, Swartz JF, Reagan K, Karasik PE, Fletcher RD. Effect on Coronary Artery Anatomy of Radiofrequency Catheter Ablation of Atrial Insertion Sites of Accessory Pathways. J Am Coll Cardiol 1993;21:1440-4.

32. Erickson CC, Walsh EP, Triedman JK, Saul JP. Efficacy and safety of radiofrequency ablation in infants and young children < 18 months of age. American.Journal.of.Cardiology 1994;74(9):944-7.

33. Walsh E. Radiofrequency catheter ablation for cardiac arrhythmias in children. Cardiol Rev 4, 200-207. 1996.

34. Blaufox AD, Paul T, Saul JP. Radiofrequency catheter ablation in small children: relationship of complications to application dose. PACE 2004;(27):224-9.

35. Rodriguez L, Leunissen J, Hoekstra A, et al. Transvenous cold mapping and cryo-ablation of the AV node in dogs: Observations of chronic lesions and comparison to those obtained using radiofrequency ablation. J Cardiovasc Electrophysiol. 1998;9:1055-1061

36. Khairy P, Chauvt P, Lehmann J, et al. Lower incidence of thrombus formation with cryoenergyversus radiofrequency catheter ablation. Circulation. 2003;107:2045-2050.

37. Skanes AC, Yee R, Krahn AD, Klein G. Cryo-ablation of atrial arrhythmias. Card Electrophysiol Rev. 2002;6:383-388.

38. Friedman PL, Cubuc M, Green MS, et al. Catheter cryoablation of supraventricular tachycardia : results of the multicenter prospectve “frosty” trial. Heart Rhythm. 2004 ;1 :129-138.


Repository Staff Only: item control page