The Pediatric Radiofrequency Ablation Registry's experience with Ebstein's anomaly. Pediatric Electrophysiology Society.

Abstract

INTRODUCTION:

Abnormal anatomy and complex electrophysiology in patients with Ebstein's anomaly of the tricuspid valve may confound attempts at radiofrequency ablation (RFA).

METHODS AND RESULTS:

Data for 65 pediatric Ebstein's patients (9.8+/-5.4 years, 4 months to 20 years; 39+/-25 kg, 5.1 to 108 kg) were obtained from the Pediatric Radiofrequency Ablation Registry. The degree of tricuspid regurgitation (DOTR) and the degree of Ebstein's anomaly were assessed with echocardiography/Doppler. Leading indications were drug refractoriness (24 [37%] of 65 patients) and life-threatening arrhythmia (14 [22%] of 65 patients). For the 65 patients, 82 typical (nondecremental) accessory pathways (APs) (62% right free wall, 34% right septal, and 4% left sided), 17 other supraventricular tachycardias (1 ectopic atrial, 7 AV reentry, 5 Mahaim, and 4 intra-atrial reentry tachycardias), and 1 ventricular mechanism were mapped. Thirty-four (52%) of 65 patients had a single AP (21 right free wall, 10 septal, and 3 left); 19 (29%) of 65 patients multiple APs; 6 (9%) of 65 patients a single AP plus a non-AP mechanism; and 6 (9%) of 65 patients non-AP mechanism(s) only. RFA acute success rates and recurrence rates for right free wall, right septal, and other mechanisms were 79%/32%, 89%/29%, and 75%/27%. Mild DOTR and a body surface area (BSA) < or = 1.7 m2 independently predicted a better acute success rate. BSA < or = 1.7 m2 also predicted long-term success.

CONCLUSION:

In this patient subset, life-threatening arrhythmias and multiple electrophysiologic mechanisms are commonly encountered during RFA. Mild DOTR and a BSA < or = 1.7 m2 predict a higher acute success rate. While acute success rates are relatively high, recurrence is frequent.

• Authors: J D Reich, D Auld, E Hulse, K Sullivan, R Campbell
• Journal: Journal of cardiovascular electrophysiology (J Cardiovasc Electrophysiol) Vol. 9 Issue 12 Pg. 1370-7 (Dec 1998) ISSN: 1045-3873 [Print] United States
• PMID: 9869537 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Catheter Ablation (adverse effects)
• Child
• Child, Preschool
• Ebstein Anomaly (complications, diagnosis, physiopathology, surgery)
• Electrophysiology
• Humans
• Infant
• Infant, Newborn
• Registries
• Retrospective Studies
• Tachycardia, Supraventricular (etiology, surgery)
• Treatment Outcome
• United States