Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. The Pediatric Electrophysiology Society

The learning curve for radiofrequency ablation of tachyarrhythmias in pediatric patients. Participating members of the Pediatric Electrophysiology Society

The results of radiofrequency ablation for treatment of supraventricular tachyarrhythmias have been reported to improve with increasing experience; however, the precise nature of the learning curve in children is unknown. From November 1990 to October 1993, 1,546 consecutive procedures from the Pediatric Radiofrequency Ablation Registry were categorized into deciles based on number of prior pediatric procedures at the submitting institution. Negative exponential models were tested for strength of relation between volume of prior experience and 4 measures of outcome: success rate, complication rate, fluoroscopy time, and procedure time. Negative exponential curves described the experience-outcome relations well (r = 0.81 to 0.97). Learning rates were most rapid for successful ablation of left free wall accessory pathways, and slowest for right free wall pathway ablation. These models suggest that, given enough experience, procedural success rates > 90% (regardless of pathway location) and fluoroscopy and procedure times averaging < 40 minutes and 250 minutes, respectively, can be achieved in pediatric patients.

Catheter ablation of the accessory pathways of the Wolff-Parkinson-White syndrome and its variants

The basis of arrhythmias in the Wolff-Parkinson-White (WPW) syndrome and its variants is the presence of accessory atrioventricular connections. Those variants include the concealed form of the WPW syndrome, the permanent form of junctional reciprocating tachycardia, and Mahaim preexcitation. In all forms of symptomatic WPW syndrome, catheter ablation of the accessory atrioventricular connections using radiofrequency current has become the treatment of choice. This review traces the development of this therapy, outlines the basics of the technique, summarizes the results reported in the largest series, indicate remaining areas of controversy, and discusses the indications and limitations of radiofrequency ablation therapy.