Josep Brugada Terradellas, Miquel
Rissech Payret*, Lluís Mont Girbau, Guillermina Fita Rodriguez**, Joaquim Bartrons
Casas*, Mariona Matas Avella, Carlos Mortera Pérez*, Francisco Navarro-López.
Arrhythmia Unit, Institut de Malaties Cardiovasculars, Hospital Clínic,
Barcelona, *Pediatric Cardiology Unit, Hospital Sant Joan de Deu, Barcelona,
**Anesthesia Service, Hospital Clínic, Barcelona, Spain
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Objectives. The use of radiofrequency
ablation of cardiac arrhythmias in pediatrics requires demonstration that the technique is
effective and devoid of significant complications. In this study we present our experience
in ablation in pediatrics and young.
Patients and methods. Between January 1992 and January 1997 we
performed a total of 1543 radiofrequency ablation procedures. Of them, 130 were performed
in 117 patients younger than 18 years old (58 were younger than 14 years old). Indication
for ablation was the presence of drug refractory recurrent paroxysmal supraventricular
tachycardia in 112 patients and permanent ventricular preexcitation in 5 asymptomatic
patients. Final diagnosis in the 112 symptomatic patients was: 4 atrial tachycardias, 21
atrio-ventricular nodal reentrant tachycardias, 53 Wolff-Parkinson-White (WPW) syndromes,
33 orthodromic tachycardias using a concealed accessory pathway and 1 idiopathic left
ventricular tachycardia.
Results. The initial ablation procedure was effective in 109/117
patients (93%) with a total duration of 90 ± 31 minutes, using 16 ± 11 minutes of
radioscopy and a median of 4 radiofrequency applications. During follow-up recurrence
occurred in 9 patients (8%). In 7 out of them and 6 of the unsuccessful in the initial
procedure a second effective procedure was performed in 11/13 patients. Finally,
radiofrequency ablation was effective in 111/117 patients (95%). We observed a single
complication in a 15-year-old girl who presented a thrombosis of the right femoral artery
requiring balloon recanalization. Comparison of these results with those in the adult
population showed no differences in terms of effectiviness, recurrences and complications.
Conclusions. Radiofrequency ablation of cardiac arrhythmias in
pediatrics and young people can be safely and effectively done. Results are similar to
those obtained in adults suggesting that indications for ablation can also be similar.
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