Population-based study confirms radiofrequency catheter ablation as safe and effective in paediatric patients

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A new population-based study confirms previous study reports that radiofrequency catheter ablation is a safe method of arrhythmia treatment in children with long-term cumulative efficacy exceeding 90%, and a highly significant decrease in the procedure and fluoroscopy time during the study period.

Radiofrequency catheter ablation is nowadays considered the standard of care for the majority of paediatric patients with supraventricular tachycardia, leading to symptom elimination and quality-of-life improvement. However, population-based data on its safety and long-term efficacy is lacking. Therefore, Peter Kubus (Children’s Heart Centre, University Hospital Motol, Prague, Czech Republic) et al aimed to evaluate the long-term utilisation and results of paediatric radiofrequency catheter ablation in a population-based study in the Czech Republic.

In the retrospective study, published ahead-of-print in Europace, researchers reviewed data from three centres performing paediatric radiofrequency catheter ablation for the whole population of the Czech Republic between 1993 and 2010. A total of 708 ablation procedures in 633 consecutive patients ˂18 years (median age at procedure: 14.9 years) for 716 different substrates were tracked, with 439 (61.3%) accessory pathways and 205 (28.6%) atrioventricular nodal re-entry tachycardia being most frequent. Forty three (6.8%) patients had congenital heart disease.

The study shows that the incidence of radiofrequency catheter ablation reached 0.049 per 1,000 children ˂18 years from 2006–2010. Indications for radiofrequency catheter ablation included patient preference (68%), drug refractoriness (15.5%), asymptomatic Wolff-Parkinson-White pre-excitation (8.4%), malignant arrhythmia (6.1%), tachycardia-induced cardiomyopathy (1%) and planned total cavopulmonary connection (1%).

The researchers report that median follow-up was 13.7 months. Recurrence was tracked for each treated arrhythmia substrate and defined as one or more of the following: documented original arrhythmia, symptoms highly suggestive of recurrence of pre-excitation. Overall acute/long-term success of the primary procedure (defined as the absence of recurrence within the reported follow-up interval) was 89.1/77.2%. Re-ablation was performed in 73 of 163 substrates after a primary unsuccessful ablation resulting in long-term cumulative efficacy of 96.3%.

The findings show that comparing 1993–2005 (early ablation period) with 2006–2010 (recent ablation period) the incidence of utilisation of catheter ablation increased from 0.029 to 0.049 per 1,000 children and procedure/fluoroscopy time decreased from median 154/24 to 105/14 minutes (p˂0.001 for both). Serious complications occurred in nine patients (1.4%).

According to the authors, “the reported incidence (in the recent ablation period of 2006–2010) of 0.049 ablation procedure per 1,000 children ˂18 years of age is probably approaching a steady rate, and this may serve as important information to predict resource utilisation while planning delivery of this highly specialised care.”

The study was funded by the Ministry of Health, Czech Republic.

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