Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-28T12:59:59.891Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk factors of recurrence and complication in radiofrequency catheter ablation of atrioventricular reentrant tachycardia in children and adolescents

Published online by Cambridge University Press:  18 January 2013

Tien H. Chen ,
Ming-Lung Tsai ,
Po-Cheng Chang ,
Hung-Ta Wo ,
Chung-Chuan Chou ,
Ming-Shien Wen ,
Chun-Chieh Wang ,
San-Jou Yeh  and
Delon Wu
Tien H. Chen*
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Ming-Lung Tsai*
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Po-Cheng Chang
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Hung-Ta Wo
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Chung-Chuan Chou
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Ming-Shien Wen
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Chun-Chieh Wang
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
San-Jou Yeh
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
Delon Wu
Affiliation:
Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, Taipei, Taiwan
*
Correspondence to: T. H. Chen, M.-L. Tsai contributed equally to this study. Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 199 Tung Hwa North Road, Taipei, Taiwan. Tel: +886 3 3281200, ext:8115; Fax: +886 3 33281541.
Correspondence to: T. H. Chen, M.-L. Tsai contributed equally to this study. Second Division of Cardiology, Department of Internal Medicine, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 199 Tung Hwa North Road, Taipei, Taiwan. Tel: +886 3 3281200, ext:8115; Fax: +886 3 33281541.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

To compare potential risk factors for complications and recurrence after radiofrequency catheter ablation in symptomatic atrioventricular reentrant tachycardia in children and adolescents.

Methods

We retrospectively reviewed the data of 213 consecutive patients with symptomatic atrioventricular reentrant tachycardia who underwent both electrophysiological study and radiofrequency catheter ablation, divided these patients into two groups, children (age <12 years) and adolescents (12 ≤ age < 18 years), and compared the location of the accessory pathway, success rate, recurrence rate, complications, presence of congenital heart disease, presence of intermittent ventricular pre-excitation, and presence of Wolff–Parkinson–White syndrome in the two groups.

Results

The position of the accessory pathway was mostly right sided in children (61.3%) and left sided in adolescents (61.5%). Children had significantly more congenital heart disease than adolescents (6.4% versus 0.8%). Univariate analysis showed children or adolescents with right-sided accessory pathways to be 6.84 times and those with accessory pathways on both sides of the septum 25 times more likely to relapse than those with a single accessory pathway. Multivariate analysis indicated that children or adolescents with two accessory pathways were six times, and those with intermittent ventricular pre-excitation nine times more at risk of relapsing following radiofrequency ablation than those with single accessory pathways. All five complications occurred in children.

Conclusions

The findings suggest that the position and number of accessory pathways and presence of intermittent ventricular pre-excitation are related to risks of recurrence of atrioventricular reentrant tachycardia in children and adolescents.

Keywords

Atrioventricular reentrant tachycardiaradiofrequency catheter ablationrisk factorintermittent ventricular pre-excitation
Type
Original Articles
Information
Cardiology in the Young , Volume 23 , Issue 5 , October 2013 , pp. 682 - 691
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Ko, JK, Deal, BJ, Strasburger, JF, Benson, DW Jr. Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 1992; 69: 1028–1032.Google Scholar
2. Nielsen, JC, Kottkamp, H, Piorkowski, C, Gerds-Li, JH, Tanner, H, Hindricks, G. Radiofrequency ablation in children and adolescents: results in 154 consecutive patients. Europace 2006; 8: 323–329.Google Scholar
3. Friedman, RA, Walsh, EP, Silka, MJ et al. NASPE Expert Consensus Conference: radiofrequency catheter ablation in children with and without congenital heart disease. Report of the writing committee. North American Society of Pacing and Electrophysiology. Pacing Clin Electrophysiol, 2002; 25: 1000–1017.Google Scholar
4. Van Hare, GF, Javitz, H, Carmelli, D, et al. Prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 2004; 1: 188–196.Google Scholar
5. Lee, PC, Hwang, B, Chen, SA, et al. The results of radiofrequency catheter ablation of supraventricular tachycardia in children. Pacing Clin Electrophysiol 2007; 30: 655–661.CrossRefGoogle ScholarPubMed
6. Kugler, JD, Danford, DA, Houston, KA, Felix, G. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002; 13: 336–341.Google Scholar
7. Van Hare, GF, Javitz, H, Carmelli, D, et al. Prospective assessment after pediatric cardiac ablation: demographics, medical profiles, and initial outcomes. J Cardiovasc Electrophysiol 2004; 15: 759–770.CrossRefGoogle ScholarPubMed
8. Calkins, H, Yong, P, Miller, JM, 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. Circulation 1999; 99: 262–270.CrossRefGoogle ScholarPubMed
9. 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: 492–499.Google Scholar
10. Case, CL, Gillette, PC, Oslizlok, PC, Knick, BJ, Blair, HL. Radiofrequency catheter ablation of incessant, medically resistant supraventricular tachycardia in infants and small children. J Am Coll Cardiol 1992; 20: 1405–1410.Google Scholar
11. Kugler, JD, Danford, DA, Deal, BJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society. N Engl J Med 1994; 330: 1481–1487.CrossRefGoogle ScholarPubMed
12. Wang, L, Yao, R. Radiofrequency catheter ablation of accessory pathway-mediated tachycardia is a safe and effective long-term therapy. Arch Med Res 2003; 34: 394–398.Google Scholar
13. Bae, EJ, Ban, JE, Lee, JA, et al. Pediatric radiofrequency catheter ablation: results of initial 100 consecutive cases including congenital heart anomalies. J Korean Med Sci 2005; 20: 740–746.Google Scholar
14. Haissaguerre, M, Marcus, F, Poquet, F, Gencel, L, Le Metayer, P, Clementy, J. Electrocardiographic characteristics and catheter ablation of parahissian accessory pathways. Circulation 1994; 90: 1124–1128.Google Scholar
15. Pruszkowska-Skrzep, P, Pluta, S, Lenarczyk, A, et al. A comparison of the clinical course of preexcitation syndrome in children and adolescents and in adults. Cardiol J 2007; 14: 384–390.Google ScholarPubMed
16. Saul, JP, Hulse, JE, De, W, et al. Catheter ablation of accessory atrioventricular pathways in young patients: use of long vascular sheaths, the transseptal approach and a retrograde left posterior parallel approach. J Am Coll Cardiol 1993; 21: 571–583.Google Scholar
17. Calkins, H, Langberg, J, Sousa, J, et al. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff–Parkinson–White syndrome. Circulation 1992; 85: 1337–1346.Google Scholar
18. Jackman, WM, Wang, XZ, Friday, KJ, et al. Catheter ablation of accessory atrioventricular pathways (Wolff–Parkinson–White syndrome) by radiofrequency current. N Engl J Med 1991; 324: 1605–1611.Google Scholar
19. Yeh, SJ, Wang, CC, Wen, MS, et al. Characteristics and radiofrequency ablation therapy of intermediate septal accessory pathway. The Am J Cardiol 1994; 73: 50–56.Google Scholar
20. Fuenmayor, AJ, Fuenmayor, AM. Paediatric radiofrequency ablation experience at a Venezuelan cardiology facility. Int J Cardiol 2009; 134: 176–179.Google Scholar
21. Langberg, JJ, Calkins, H, Kim, YN, et al. Recurrence of conduction in accessory atrioventricular connections after initially successful radiofrequency catheter ablation. J Am Coll Cardiol 1992; 19: 1588–1592.Google Scholar
22. Santinelli, V, Radinovic, A, Manguso, F, et al. The natural history of asymptomatic ventricular pre-excitation. A long-term prospective follow-up study of 184 asymptomatic children. J Am Coll Cardiol 2009; 53: 275–280.Google Scholar
23. Chen, SA, Hsia, CP, Chiang, CE, et al. Reappraisal of radiofrequency ablation of multiple accessory pathways. Am Heart J 1993; 125: 760–771.Google Scholar
24. Iwa, T, Magara, T, Watanabe, Y, Kawasuji, M, Misaki, T. Interruption of multiple accessory conduction pathways in the Wolff–Parkinson–White syndrome. Ann Thorac Surg 1980; 30: 313–325.Google Scholar
25. Klein, GJ, Gulamhusein, SS. Intermittent preexcitation in the Wolff–Parkinson–White syndrome. Am J Cardiol 1983; 52: 292–296.Google Scholar
26. Danford, DA, Kugler, JD, Deal, B, et al. The learning curve for radiofrequency ablation of tachyarrhythmias in pediatric patients. Participating members of the Pediatric Electrophysiology Society. Am J Cardiol 1995; 75: 587–590.Google Scholar