Ablation of Tachyarrhythmia in Small Children Under One Year Old

Liliya Svintsova1, Sergey Popov1, Sergey Krivolapov1, Roman Batalov1, Igor Kovalev1,2
1 Pediatric Cardiology Department, Federal State Budgetary Scientific Institution "Research Institute for Cardiology", Russia
2 Pediatric Cardiology and Arrhythmology Department, Research and Clinical Institute for Pediatrics at the Pirogov Russian National Research Medical University, Russia

The aim of the study was to evaluate the safety and efficacy of RFA in critically ill small children (< 1 year of age) with drug resistant tachycardia accompanied by arrhythmogenic cardiomyopathy and heart failure.

Material: The study included 25 patients aged 5.1 ± 3.6 months. Wolff-Parkinson-White syndrome and atrial tachycardia were detected in sixteen (60 %) and ten (40 %) patients, respectively. Patients with structural heart pathology, including congenital heart diseases and laboratory-confirmed myocarditis, were excluded from the study.

Results: The indication for RFA was drag refractory supraventricular tachycardia (SVT) accompanied by arrhythmogenic cardiomyopathy and heart failure. Unsuccessful ablation was observed in two 1-month-old patients who underwent successful ablation 3 months later. The follow-up periods ranged from 0.3 to 10 years (average 5.2 years). Only two patients (10%) had tachycardia recurrence 1 and 2 months after RFA, respectively. The RFA success rate was 92%. The study did not show any procedure-related complications. Heart failure disappeared within 5–7 days after RFA. Complete normalization of cardiac chambers sizes was documented within 1 month after effective RFA. A three-dimensional CARTO system was used in three patients with body weight > 7 kg. The use of the CARTO system resulted in a remarkable decrease of the fluoroscopy time without vascular injury or other procedure-related complications in all cases.

Conclusions: Our study suggested that RFA may be considered as the method of choice for SVT treatment in small children when drug therapy is ineffective and arrhythmogenic cardiomyopathy progresses.