Background: Radiofrequency ablation (RFA) has been shown to be effective in young children although significant complications were reported.
Methods: Thirty six procedures were done in 29 patients (16 female), age 11 days to 23 months (median 4 months), who were brought to the EP lab with the intention to perform RFA for tachycardia which was life-threatening or refractory to medical therapy. Diagnoses were atrio-ventricular bypass tracts (12), PJRT (5), ectopic atrial tachycardia (EAT) (7), atrial flutter (2), ventricular tachycardia (VT) (1), and congenital JET (2). There were 6 children with congenital heart disease and one with myocarditis. Fifteen presented with severe congestive heart failure (3 on ECMO support). In 3 patients RFA was not done because of complications (1) or technical difficulties.
Results: The overall success rate was 73% (19/26) patients. Six patients underwent 2 procedures and 1 patient required 3 procedures. RFA was successful in 88% (14/16) children with AV bypass tracts, (failed in 1 with Ebstein anomaly and in 1 with bilateral epicardial tracts), in 2/4 patients with EAT, in 1 with LV VT, and in 1 of 2 patients with congenital JET (1 cured, 1 improved). One infant with multifocal atrial tachycardia underwent AV node ablation and pacemaker implantation. The complication rate was 11% (4/36 procedures): complete heart block, hemopericardium requiring pericardiocentesis and right femoral artery occlusion in 2 patients.
Conclusion: RFA is effective in infants with tachyarrhythmia refractory to medical therapy. The procedure should be reserved for selected patients because of an increased risk of complications.