Pediatric radiofrequency catheter ablation - Sedation methods and success, complication and recurrence rates

Background: There remains to be issues regarding radiofrequency catheter ablation (RFCA) in pediatric patients that are different to those involving adults. This study was performed to determine the efficacy and safety of RFCA in pediatric patients. Methods and Results: During the period from 1992 to 2003, 2,734 patients underwent RFCA and 131 pediatric patients who were ≤15 years old (70 males, mean age 12.0±3.1 years) were analyzed, retrospectively. The number of accessory pathways (APs) mediating atrioventricular re-entrant tachycardia was 93 (71.4%) and atrioventricular nodal re-entrant tachycardia (AVNRT) was 27 (20.5%). The most common indications for the RFCA were the 'patient's choice' in 94 (71.2%) and 'medically refractory tachycardia' in 29 (22.0%). The age-related indication of the 'patient's choice' was 80.4% (82 of 102) for those >10 years old and 40.0% (12 of 30) for those ≤10 years old (p=0.01). RFCA was performed without sedation in 87.3% (89 of 102) of the subjects >10 years old as compared to 20.0% (6 of 30) of those ≤10 years old (p=0.01). The success rate was 92.8% (90 of 97 APs) for the ablation of APs, and 96.3% (26 of 27) for that of AVNRT. The overall complication rate was 3.8% (5 of 131). During a mean follow-up duration of 13.1±2.5 months, the freedom of recurrence was 87.8% (79 of 90) for the arrhythmia associated with APs and 92.3% (24 of 26) for AVNRT. Conclusion: RFCA in pediatric patients had a good success rate with acceptable recurrence and complication rates when compared to adult patient results. Therefore, RFCA could be considered as the first line of therapy for arrhythmias with concealed and manifested APs and AVNRT in pediatric patients.