Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica: Risultati immediati e di un follow-up a medio termine

Translated title of the contribution: Transcatheter radiofrequency ablation of supraventricular tachycardia in children: Early results and mid-term follow-up

Annibale Sandro Montenero, Fabrizio Drago, Filippo Crea, Carmelita Varano, Sergio Guarneri, Adriano Cipriani, Gemma Pelargonio, Domenico Antonio Agostino, Fulvio Bellocci, Pietro Ragonese, Paolo Zecchi

Research output: Contribution to journalArticle

Abstract

OBJECTIVES. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS. Forty-six pediatric patients (mean age 12.6 years, range 3-18 ) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS. To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transeptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS. Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6%). Mean fluoroscopy time was 31 ± 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 ± 10 min and with transeptal 23 ± 12 min (p <0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50%). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100% in patients with an accessory pathway and 33% in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. Complications: Major complications (6,5%) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS. Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.

Original languageItalian
Pages (from-to)31-40
Number of pages10
JournalGiornale Italiano di Cardiologia
Volume26
Issue number1
Publication statusPublished - Jan 1996

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Montenero, A. S., Drago, F., Crea, F., Varano, C., Guarneri, S., Cipriani, A., Pelargonio, G., Agostino, D. A., Bellocci, F., Ragonese, P., & Zecchi, P. (1996). Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica: Risultati immediati e di un follow-up a medio termine. Giornale Italiano di Cardiologia, 26(1), 31-40.