Experience on the Invasive Treatment of Supraventricular Tachycardia and Accessory Pathways in Pediatric Patients

pp. 320-325

Abstract

Background: Supraventricular tachycardia secondary to accessory pathways is the most prevalent symptomatic tachyarrhythmia in pediatric patients and its invasive approach is consistently growing.

Objectives: The aim of this study was to evaluate the experience of surgical treatment of supraventricular tachycardia in pediatric patients.

Methods: This was a retrospective cohort study including patients below 18 years of age undergoing electrophysiological study and radiofrequency ablation of supraventricular tachycardia and accessory pathways. Types of substrate, accessory pathway location, presence of congenital heart disease, results, procedure complications and recurrence during follow-up were analyzed.

Results: A total of 416 patients were identified. Average age was 13 years (range 2-18) and 275 were male patients (67%). Twenty patients (5%) had congenital heart disease, 286 (69%) accessory pathways and 130 (31%) other mechanisms of supraventricular tachycardia, including double nodal physiology in 109 patients (26%), ectopic atrial tachycardia in 14 (3%) and atrial flutter in 7 (2%). The efficacy in accessory pathway ablation was 94.7%. Six patients (1.4%) presented with complications: one had a stroke, one complete atrioventricular block, one femoral artery thrombosis and 3 mild pericardial effusion. Accessory pathways recurred in 26 patients (9.8%). One hundred percent efficacy was observed in double nodal physiology with recurrence in 2 patients. (3.2%) Efficacy in atrial tachycardia treatment was 86% and recurrence occurred in 2 patients (14.2%) without complications. Atrial flutter ablation was successful and without complications. No recurrences were observed during an average 67-month follow-up period (range 2-114).

Conclusions: Surgical treatment of supraventricular tachycardia in pediatric patients is an effective and safe therapeutic tool with a low rate of complications and recurrence during follow-up.