Hostname: page-component-7479d7b7d-68ccn Total loading time: 0 Render date: 2024-07-10T23:10:20.604Z Has data issue: false hasContentIssue false
  • English
  • Français

Catheter ablation in children with supraventricular tachycardia mediated by accessory pathways—use of radiofrequency current as a first line of therapy

Published online by Cambridge University Press:  19 August 2008

Joachim Hebe ,
Michael Schlüter  and
Karl-Heinz Kuck
Joachim Hebe
Affiliation:
From the Department of Cardiology, University Hospital Eppendorf, Hamburg
Michael Schlüter
Affiliation:
From the Department of Cardiology, University Hospital Eppendorf, Hamburg
Karl-Heinz Kuck*
Affiliation:
From the Department of Cardiology, University Hospital Eppendorf, Hamburg
*
Prof. Karl-Heinz Kuck, Department of Cardiology, University Hospital Eppendorf, Martinistraße 52, 20246 Hamburg, Germany. Tel. (4940) 4717-4980; Fax. (4940) 4717-4125.
Get access Rights & Permissions [Opens in a new window]

Abstract

Catheter ablation of an accessory atrioventricular pathway using 500 kHz radiofrequency current was attempted in 53 children and young adolescents less than 16 years of age (mean 9.3±4.1 years) who were referred for treatment of symptomatic supraventricular tachycardia. Thirty children had the Wolff-Parkinson-White syndrome and 23 had tachyarrhythmias related to an accessory pathway conducting only in retrograde fashion. Of the latter, seven were found to have the permanent form of junctional reciprocating tachycardia, which had resulted in depressed left ventricular function in four. Ablation of left-sided accessory pathways was usually attempted utilizing an arterial approach to the annulus of the mitral valve, while the venous route to the atrial aspect of the tricuspid valvar annulus was chosen for right-sided accessory connections. To reduce invasiveness and the duration of the procedure, a technique with a solitary catheter was attempted in 20 children with the Wolff-Parkinson-White syndrome, regardless of the anatomical site of the accessory pathway. Ablation of 54 of 56 accessory connections was achieved in 51 patients (96% success) with a median of six applications of radiofrequency current. The sessions were completed within 3.4±2.2 hours, with a median exposure to radiation of 31.1 minutes. During a 10-month period of follow- up, no patient required antiarrhythmic medication, and 51 children (96%) were completely free of any symptoms related to arrhythmias. Left ventricular function returned to normal in the four children with tachycardia-induced cardiomyopathy. Except for a patient with an arterial thrombotic occlusion, no serious complications were encountered. Catheter ablation using radiofrequency current is a highly effective and safe curative approach for treating young patients with supraventricular tachycardias mediated by accessory pathways. The use of fewer catheters of smaller size is feasible and advisable in this cohort of patients.

Keywords

Wolff-Parkinson-White syndromeaccessory pathwayssupraventricular tachycardiapermanent junctional reciprocating tachycardiacatheter ablationradiofrequency current
Type
World Forum for Pediatric Cardiology Young Investigator Finalists
Information
Cardiology in the Young , Volume 4 , Issue 1 , January 1994 , pp. 28 - 36
Copyright
Copyright © Cambridge University Press 1994

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

Wellens, HJ, Durrer, D. Wolff-Parkinson-White syndrome and atrial fibrillation. Relation between refractory period of accessory pathway and ventricular rate during atrial fibrillation. Am J Cardiol 1974; 34: 777–782.CrossRefGoogle ScholarPubMed
McGuire, MA, Lau, KC, Davis, LM, Knight, P, Uther, JB, Ross, DL.Permanent junctional reciprocating tachycardia misdiagnosed as cardiomyopathy. Aust NZ J Med 1991; 21: 239–241.CrossRefGoogle ScholarPubMed
Chien, WW, Cohen, TJ, Lee, MA, Lesh, MD, Griffin, JC, Schiller, NB, Scheinman, MM.Electrophysiological findings and long-term follow-up of patients with the permanent form of junctional reciprocating tachycardia treated by catheter ablation. Circulation 1992; 85: 1329–1336.CrossRefGoogle ScholarPubMed
Jackman, WM, Wang, X, Friday, KJ, Roman, CA, Moulton, KP, Beckman, KJ, McClelland, JH, Twidale, N, Hazlitt, A, Prior, MI, Margolis, PD, Calame, JD, Overholt, ED, Lazzara, R. Catheterablation of accessory atrioventricular pathways (Wolff Parkinson-White syndrome) by radiofrequency current. N Engl J Med 1991; 324: 1605–1611.CrossRefGoogle Scholar
Kuck, KH, Schlüter, M, Geiger, M, Siebels, J, Duckeck, W. Radiofrequency current catheter ablation of accessory atrioventricular pathways. Lancet 1991; 337: 1557–1561.CrossRefGoogle ScholarPubMed
Schlüter, M, Geiger, M, Siebels, J, Duckeck, W, Kuck, KH.Catheter ablation using radiofrequency current to cure symptomatic patients with tachyarrhythmias related to an accessory atrioventricular pathway. Circulation 1991; 84: 1644–1661.CrossRefGoogle Scholar
Calkins, H, Langberg, J, Sousa, J, el-Atassi, R, Leon, A, Kou, W, Kalbfleisch, S, Morady, F.Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Abbreviated therapeutic approach to Wolff-Parkinson-White syndrome. Circulation 1992; 85: 1337–1346.CrossRefGoogle ScholarPubMed
Leather, RA, Leitch, JW, Klein, GJ, Guiraudon, GM, Yee, R, Kim, YH.Radiofrequency catheter ablation of accessory pathways: a learning experience. Am J Cardiol 1991; 68: 1651– 1655.CrossRefGoogle ScholarPubMed
Lesh, MD, Van Hare, GF, Schamp, DJ, Chien, W, Lee, MA, Griffin, JC, Langberg, JJ, Cohen, TJ, Lurie, KG, Scheinman, MM.Curative percutaneous catheter ablation using radiofrequency energy for accessory pathways in all locations: results in 100 consecutive patients. J Am Coll Cardiol 1992; 19: 1303–1309.CrossRefGoogle ScholarPubMed
Perry, JC, Garson, A Jr. Supraventricular tachycardia due to Wolff-ParkinsonWhite syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol 1990; 16: 1215–1220.CrossRefGoogle Scholar
Van Hare, GF, Lesh, MD, Scheinman, M, Langberg, JJ.Percutaneous radiofrequency catheter ablation for supraventricular arrhythmias in children.J Am Coll Cardiol 1991; 17: 1613– 1620.CrossRefGoogle ScholarPubMed
Dick, M II, O'connor, BK, Serwer, GA, LeRoy, S, Armstrong, B.Use of radiofrequency current to ablate accessory connections in children. Circulation 1991; 84: 2318–2324.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Kuck, KH, Schlüter, M.Single-catheter approach to radiofrequency current ablation of left-sided accessory pathways in patients with Wolff-Parkinson-White syndrome. Circulation 1991; 84: 2366–2375.CrossRefGoogle ScholarPubMed
Schlüter, M, Kuck, KH. Radiofrequency current for catheter ablation of accessory atrioventricular connections in children and adolescents. Emphasis on the single-catheter technique. Pediatrics 1992; 89: 930–935.CrossRefGoogle ScholarPubMed
Kunze, KP, Schlüter, M, Costard, A, Nienaber, CA, Kuck, KH.Right atrial thrombus formation after transvenous catheter ablation of the arrioventricuiar node. J Am Coll Cardiol 1985; 6: 1428–1430.CrossRefGoogle ScholarPubMed
Hebe, J, Cappato, R, Chiladakis, I, Duckeck, W.Retrograde P-wave polarity as a predictor of accessory pathway location in the permanent form of junctional reciprocating tachycardia. Circulation 1992; 86(Suppl Iyes): I 202. [Abstract]Google Scholar
Haines, DE, Watson, DD.Tissue heating during radiofrequency catheter ablation: a thermodynamic model and observations in isolated perfused and superfused canine right ventricular free wall. PACE 1989; 12: 962–976.CrossRefGoogle ScholarPubMed
Borggrefe, M, Budde, T, Podczeck, A, Breithardt, G.High frequency alternating current ablation of an accessory pathway in humans. J Am Coll Cardiol 1987; 10: 576–582.CrossRefGoogle ScholarPubMed
Kuck, KH, Jackman, W, Pitha, J, Carmen, L, Kunze, KP, Schröder, S, Nienaber, CA.Percutaneous catheter ablation at mitral anulus using a bipolar epicardial-endocardial electrode configuration. PACE 1986; 9: 287. [Abstract]Google Scholar
Kuck, KH, Kunze, KP, Schlüter, M, Geiger, M, Jackman, WM, Naccarelli, GV.Modification ofa left-sided accessory atrioventricular pathway by radiofrequency current using a bipolar epicardial-endocardial electrode configuration. Eur Heart J 1988; 9: 927–932.CrossRefGoogle Scholar
Kuck, KH, Kunze, KP, Schiüter, M, Geiger, M, Jackman, WM.Ablation of a left-sided free-wall accessory pathway by percutaneous catheter application of radiofrequency current in a patient with the Wolff-Parkinson-White syndrome. PACE 1989; 12: 1681–1690.CrossRefGoogle Scholar
Langberg, JJ, Lee, MA, Chin, MC, Rosenqvist, M.Radio-frequency catheter ablation: the effect of electrode size on lesion volume in vivo. PACE 1990; 13: 1242–1248.CrossRefGoogle Scholar
Jackman, WM, Wang, X, Friday, KJ, Fitzgerald, DM, Roman, C, Moulton, K, Margolis, D, Bowman, AJ, Kuck, KH, Naccarelli, GV, Pitha, JV, Dyer, J, Lazzara, R.Catheter ablation of the atrioventricular junction using radiofrequency current in seventeen patients: comparison of standard and large tip catheter electrodes. Circulation 1991; 83: 1562–1576CrossRefGoogle ScholarPubMed
Kuck, KH, Friday, KJ, Kunze, KP, Schlüter, M, Lazzara, R, Jackman, WM.Sites of conduction block in accessory atrioventricular pathways. Basis for concealed accessory pathways. Circulation 1990; 82: 407–417.CrossRefGoogle ScholarPubMed
Gallagher, JJ, Pritchett, EL, Sealy, WC, Kasell, J, Wallace, AG.The preexcitation syndromes. Prog Cardiovasc Dis 1978; 20: 285–327.CrossRefGoogle ScholarPubMed
De Buitleir, M, Sousa, J, Bolling, SF, el-Atassi, R, Calkins, H, Langberg, JJ, Kou, WH, Morady, F.Reduction in medical care cost associated with radiofrequency catheter ablation ofaccessory pathways. Am J Cardiol 1991; 68: 1656–1661.CrossRefGoogle ScholarPubMed