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Effect of radiofrequency catheter ablation of accessory pathways on autonomic tone in children

Published online by Cambridge University Press:  19 August 2008

Ruchir Sehra ,
Joyce E. Hubbard ,
Susan P. Straka ,
Naomi S. Fineberg ,
Douglas P. Zipes  and
Erica D. Engelstein
Ruchir Sehra
Affiliation:
Department of Pediatrics, Riley Hospital for Children and Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
Joyce E. Hubbard
Affiliation:
Department of Pediatrics, Riley Hospital for Children and Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
Susan P. Straka
Affiliation:
Department of Pediatrics, Riley Hospital for Children and Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
Naomi S. Fineberg
Affiliation:
Department of Pediatrics, Riley Hospital for Children and Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
Douglas P. Zipes*
Affiliation:
Department of Pediatrics, Riley Hospital for Children and Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
Erica D. Engelstein
Affiliation:
Department of Pediatrics, Riley Hospital for Children and Department of Medicine, Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, USA
*
Douglas P. Zipes, MD, Krannert Institute of Cardiology, 1111 West 10th Street, Indianapolis, IN 46202–800, USA. Tel: +1 (317) 630 6640; Fax: +1 (317) 274 7143; e-mail: dzipes@iupui.edu
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Abstract

Background

Radiofrequency catheter ablation is standard treatment for children with re-entrant supraventricular tachycardias. Autonomic changes have been noted after such ablation for atrioventricular nodal re-entry tachycardia, but not as well documented with atrioventricular re-entry over an accessory pathway.

Methods and results

In 10 normal paediatric volunteers and 12 children referred for electrophysiologic testing and radiofrequency ablation of supraventricular tachycardia, non-invasive autonomic function tests and tilt-table testing were performed, and the variability in 24-h heart rate was analysed. Patients with supraventricular tachycardia underwent these tests both 24–72 h before and 24 h after ablation. Patients with tachycardia underwent additional autonomic testing to assess the sensitivity of baroreceptors and the intrinsic heart rate with autonomic blockade immediately before and after ablation. One non-invasive autonomic function test, namely handgrip, demonstrated significant differences (p < 0.05) in diastolic blood pressure before and after ablation, though these values did not differ from controls. Significant decreases were noted in two indexes of the variability of heart rate before and after ablation (p < 0.05). Certain tilt test variables also demonstrated significant differences between controls and those with tachycardia subsequent to ablation. Intracardiac testing demonstrated changes (p < 0.05) in sinus cycle lengths, effective refractory periods and/or blood pressures at baseline and during testing of the sensitivity of baroreceptors before and after ablation. These changes were consistent with increased sympathetic or decreased parasympathetic tone. With autonomic blockade, these differences were abolished.

Conclusions

Catheter ablation of accessory pathways in children was associated with changes consistent with increased sympathetic or decreased parasympathetic tone. These autonomic changes persisted 24 h after the ablation procedure.

Keywords

Ablationautonomic nervous systempaediatricstachycardiaWolff-Parkinson-White syndrome
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 4 , July 1999 , pp. 377 - 383
Copyright
Copyright © Cambridge University Press 1999

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References

1.Kulgler, JD, Danford, DA, Deal, BJ, Gilette, PJ, Perry, J, Silka, MJ, van Hare, GF. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. N Engl J Med 1994; 330: 1481–1487.CrossRefGoogle Scholar
2.Wilhelmy, R., Pitschner, H, Neuzner, J, Dursch, M, Konig, S, Kerchoff-Klink, . Patients with AV nodal reentrant tachycardias show a reduced vagal impact on heart rate compated with healthy subjects with further decrease of vagal tone after radiofrequency catheter modification. Clin Sci 1996; 91 (suppl.): 125.Google Scholar
3.Kocovic, D, Shea, J, Friedman, PL. Evidence for parasympathetic denervation of the sinus node after radiofrequency modification of the A-V node in patients with A-V nodal reentry. J Am Coll Cardiol 1993; 21: 50A (abstr).Google Scholar
4.Ehlett, FA, Goldberger, JJ, Brooks, R, Miller, S, Kadish, AH. Persistent Inappropriate sinus tachycardia after radiofrequency current cathetet modification of the atrioventricular node. Am J Cardiol 1992; 69: 1092–1095.Google Scholar
5.Skeberis, V, Simonis, F, Andries, E, Brugada, P. Inappropriate sinus tachycardia after radiofrequency ablation of AV nodal tachycardia, incidence and clinical significance. J Am Coll Cardiol. 1993; 21: 358A (abstt).Google Scholar
6.Siu, D, Steinberg, JS, Jadonath, R, van Etten, P. Inappropriate sinus tachycardia aftet radiofrequency ablation of the atrioventricular nodal fast pathway. Circulation 1992; 86 (suppl. I): I–191 (abstr).Google Scholar
7.Ewing, DJ, Martyn, CN, Young, RJ, Clarke, BF. The value of cardiovascular autonomic function tests: 10 year experience in diabetes. Diabetes Care 1985; 8: 491–498.Google Scholar
8.Kapoor, WN, Brant, N. Evaluation of syncope by upright tilt testing with isoptoterenol: a nonspecific test. Ann Int Med 1992; 116: 358–363.Google Scholar
9.Friedman, PL, Stevenson, WG, Kocovic, DZ. Autonomic dysfunction after cathetet ablation. J Cardiovasc Electrophysiol 1996; 7: 450–459.Google Scholar
10.Takahashi, N, Barber, MJ, Zipes, DP. Efferent vagal innervation of canine ventricle. Am J Physiol 1985; 248: H89–97.Google ScholarPubMed
11.Martins, JB, Zipes, DP. Epicardial phenol interrupts refractory period responses to sympathetic but not vagal stimulation in canine left ventricular epicardium and endocardium. Circ Res 1980; 47: 33–40.Google Scholar
12.Inoue, H, Mahomed, Y, Kovacs, RJ, Zipes, DP. Surgery for Wolff–Parkinson–White syndrome interrupts efferent vagal innervation to the left ventricle and to the atrioventticulat node in the canine heart. Cardiovasc Res 1988; 22: 163–170.Google Scholar
13.Hartikainen, J, Kautzner, J, Heald, S, Ward, D, Malik, M, Camm, J, Rowland, E. Effect of tadioftequency cathetet ablation of supraventricular tachycardia on autonomic regulation of the sinus node. Eur Heart J 1995; 16 (suppl.): 17.Google Scholar
14.Kocovic, DZ, Harada, T, Shea, JB, Soroff, D, Friedman, . Alterations of heart rate and of heart rate variability after radiofrequency catheter ablation of supraventricuar tachycardia. Circulation 1993; 88 (pt I): 1671–1681.Google Scholar
15.O'Connot, BK, Case, CL, Vatney, FL, McKay, CA, Gillette, PC. Alterations in heart rate variability following accessory pathway ablation during childhood. PACE 1995; 18 (pt II): 875 (abstr).Google Scholar
16.Kasai, A, Omichi, C, Fujii, E, Yasuda, M, Uchida, F. Effect of radiofrequency catheter ablation on parasympathetic denervation: a comparison of three different ablation sites. PACE 1998; 21 (pt II): A713:968.Google Scholar
17.Frey, B, Heinz, G, Kreiner, G, Schmidinger, H, Weber, H, Gossinger, H. Increased heart tate variability after radiofrequency ablation. Am J Cardiol 1993; 71: 1460–1461.CrossRefGoogle Scholar