Acta Pædiatrica ISSN 0803-5253
REGULAR ARTICLE
Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents Andreas Hanslik1, Azra Mujagic1, Elisabeth Mlczoch1, Heinz G€ossinger2, Marianne Gwechenberger2, Bernhard Richter2, Manfred Marx1, Sulaima Albinni ([email protected])1 1.Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria 2.Divison of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Keywords Ablation, Arrhythmia, Children, Radiofrequency, Recurrence Correspondence Sulaima Albinni, MD, Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, €rtel 18-20, 1090 Vienna, Austria. Waehringer Gu Tel: +43 1 40400 3154 | Fax: +43 1 40400 3154 | Email: [email protected] Received 11 December 2013; revised 13 January 2014; accepted 27 January 2014. DOI:10.1111/apa.12580
ABSTRACT Aim: Radiofrequency catheter ablation is a standard treatment for tachyarrhythmia in children. Recently, several centres using cryoenergy for ablation have reported high success and low complication rates, but an increased risk of recurrence of arrhythmia. The aim of this study was to report success, complications and recurrence rates for radiofrequency catheter ablation in children under current conditions. Methods: A retrospective cohort study of 333 consecutive children undergoing radiofrequency catheter ablation over the last two decades. Results: Radiofrequency catheter ablation was performed successfully in 96.7% of patients, but was significantly less successful in patients with a right anterior or right anterolateral accessory pathway (81.8%). Overall mortality was 0%; there was only one (0.3%) major complication, a pericardial haemorrhage, and only 2.8% of the patients developed minor vascular complications at the puncture site. None of the patients developed a persistent atrioventricular block. Over a median observation time of 4.3 years (0.1; 17.8), recurrence of arrhythmia occurred in 9.3% of all patients, but 50% of children with right lateral accessory pathways. Conclusion: Radiofrequency catheter ablation can be performed with high success and very low complication rates in children. Recurrence rates are substantially lower than those reported for cryoablation in the literature.
AIM Radiofrequency catheter ablation (RFCA) is a standard treatment for tachyarrhythmia, and large studies have demonstrated the success of the procedure in children and adolescents (1–4). However, over the last decade, cryoablation has been performed by a growing number of electrophysiologists. While several studies reported high success and low complication rates, with a notably lower incidence of atrioventricular (AV) block, there has been concern about comparatively high recurrence rates after cryoablation in children (5–7). Similarly, a recent large multicentre, prospective trial randomising adult patients to either cryoablation or RFCA found significantly higher recurrence rates after cryoablation (8). Although most recent studies could demonstrate a significant decrease of recurrence after -cryoablation in children with atrioventricular nodal re-entry tachycardia (AVNRT) (9,10), other centres still report recurrence rates up to 22% (11–13). Therefore, as the discussion about the advantages and disadvantages of cryoablation compared to RFCA is still ongoing, objective outcome data of RFCA in children and adolescents under conventional mapping are needed. The aim of our study was to report success, complications and recurrence rates of RFCA in children at a single paediatric cardiology centre.
e188
PATIENTS AND METHODS Study design The study design was a retrospective cohort study of consecutive children undergoing an electrophysiology study at a tertiary care paediatric cardiology centre between January 1993 and December 2012. The study protocol was approved by the ethics committee of the Medical University of Vienna.
Key notes
Radiofrequency catheter ablation is increasingly challenged by cryoablation as a standard procedure for tachyarrhythmia in children. Our study of 333 children and adolescents undergoing radiofrequency catheter ablation found high success rates and low complication rates, as well as low recurrence rates. Further research should focus on prospective clinical trials that directly compare both ablation methods, radiofrequency catheter ablation and cryoablation, especially in young children and toddlers.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e188–e193
Hanslik et al.
Data acquisition The study centre’s database was searched for patients, between 0- and 19-years-of-age, who were scheduled for an electrophysiology examination between January 1993 and December 2012. The discharge letter, electrophysiology study protocol, results of the electrocardiogram (ECG) and transthoracic echocardiography (TTE) and reports of follow-up visits were retrieved from the study centre’s archives. The data relevant for this study was then transferred into electronic case report forms using the Windows Access© database programme. Patients were screened for complications by thorough clinical examination, continuous ECG and transcutaneous pulse oxymetry saturation monitoring during the first night after RFCA, and ECG and TTE prior to discharge. All complications detected were documented in the discharge letter. One limitation for the study was that while data on success, mortality and acute complications and recurrence could be accessed for the whole study cohort, results of TTE and ECG at discharge were only available for patients undergoing RFCA between 2000 and 2012. Follow-up All patients had clinical follow-up visits, including ECG at the study centre or at their local paediatric cardiologist 6 months after RFCA. Further follow-up was scheduled at the discretion of the attending paediatric cardiologist. Patients with recurrent arrhythmic events, tachycardia, palpitations or anomalous ECG findings (e.g. atrioventricular block, prolonged AV-conduction time, ST-segment evaluation) either presented themselves or were referred to the study centre for re-evaluation and re-ablation if indicated. Observation time was defined as the time interval between RFCA and December 2012. However, to prevent overestimation of observation time, the maximum observation time was defined as the time between RFCA and the 19th birthday of patients who reached an age of 19 years before December 2012. Statistical analysis Statistical analysis was performed using SPSS© version 20.0 for Windows© (SPSS©, Chicago, IL, USA). Continuous variables are presented as median, minimum and maximum values, categorical variables as absolute frequencies and percentages. Comparisons between groups were analysed by chi-square or Fisher’s exact test for categorical variables. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated when applicable, and multivariate analyses using logistic regression were performed to determine independent influence of various risk factors. Significance level was
REGULAR ARTICLE
Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents Andreas Hanslik1, Azra Mujagic1, Elisabeth Mlczoch1, Heinz G€ossinger2, Marianne Gwechenberger2, Bernhard Richter2, Manfred Marx1, Sulaima Albinni ([email protected])1 1.Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria 2.Divison of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Keywords Ablation, Arrhythmia, Children, Radiofrequency, Recurrence Correspondence Sulaima Albinni, MD, Division of Paediatric Cardiology, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, €rtel 18-20, 1090 Vienna, Austria. Waehringer Gu Tel: +43 1 40400 3154 | Fax: +43 1 40400 3154 | Email: [email protected] Received 11 December 2013; revised 13 January 2014; accepted 27 January 2014. DOI:10.1111/apa.12580
ABSTRACT Aim: Radiofrequency catheter ablation is a standard treatment for tachyarrhythmia in children. Recently, several centres using cryoenergy for ablation have reported high success and low complication rates, but an increased risk of recurrence of arrhythmia. The aim of this study was to report success, complications and recurrence rates for radiofrequency catheter ablation in children under current conditions. Methods: A retrospective cohort study of 333 consecutive children undergoing radiofrequency catheter ablation over the last two decades. Results: Radiofrequency catheter ablation was performed successfully in 96.7% of patients, but was significantly less successful in patients with a right anterior or right anterolateral accessory pathway (81.8%). Overall mortality was 0%; there was only one (0.3%) major complication, a pericardial haemorrhage, and only 2.8% of the patients developed minor vascular complications at the puncture site. None of the patients developed a persistent atrioventricular block. Over a median observation time of 4.3 years (0.1; 17.8), recurrence of arrhythmia occurred in 9.3% of all patients, but 50% of children with right lateral accessory pathways. Conclusion: Radiofrequency catheter ablation can be performed with high success and very low complication rates in children. Recurrence rates are substantially lower than those reported for cryoablation in the literature.
AIM Radiofrequency catheter ablation (RFCA) is a standard treatment for tachyarrhythmia, and large studies have demonstrated the success of the procedure in children and adolescents (1–4). However, over the last decade, cryoablation has been performed by a growing number of electrophysiologists. While several studies reported high success and low complication rates, with a notably lower incidence of atrioventricular (AV) block, there has been concern about comparatively high recurrence rates after cryoablation in children (5–7). Similarly, a recent large multicentre, prospective trial randomising adult patients to either cryoablation or RFCA found significantly higher recurrence rates after cryoablation (8). Although most recent studies could demonstrate a significant decrease of recurrence after -cryoablation in children with atrioventricular nodal re-entry tachycardia (AVNRT) (9,10), other centres still report recurrence rates up to 22% (11–13). Therefore, as the discussion about the advantages and disadvantages of cryoablation compared to RFCA is still ongoing, objective outcome data of RFCA in children and adolescents under conventional mapping are needed. The aim of our study was to report success, complications and recurrence rates of RFCA in children at a single paediatric cardiology centre.
e188
PATIENTS AND METHODS Study design The study design was a retrospective cohort study of consecutive children undergoing an electrophysiology study at a tertiary care paediatric cardiology centre between January 1993 and December 2012. The study protocol was approved by the ethics committee of the Medical University of Vienna.
Key notes
Radiofrequency catheter ablation is increasingly challenged by cryoablation as a standard procedure for tachyarrhythmia in children. Our study of 333 children and adolescents undergoing radiofrequency catheter ablation found high success rates and low complication rates, as well as low recurrence rates. Further research should focus on prospective clinical trials that directly compare both ablation methods, radiofrequency catheter ablation and cryoablation, especially in young children and toddlers.
©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014 103, pp. e188–e193
Hanslik et al.
Data acquisition The study centre’s database was searched for patients, between 0- and 19-years-of-age, who were scheduled for an electrophysiology examination between January 1993 and December 2012. The discharge letter, electrophysiology study protocol, results of the electrocardiogram (ECG) and transthoracic echocardiography (TTE) and reports of follow-up visits were retrieved from the study centre’s archives. The data relevant for this study was then transferred into electronic case report forms using the Windows Access© database programme. Patients were screened for complications by thorough clinical examination, continuous ECG and transcutaneous pulse oxymetry saturation monitoring during the first night after RFCA, and ECG and TTE prior to discharge. All complications detected were documented in the discharge letter. One limitation for the study was that while data on success, mortality and acute complications and recurrence could be accessed for the whole study cohort, results of TTE and ECG at discharge were only available for patients undergoing RFCA between 2000 and 2012. Follow-up All patients had clinical follow-up visits, including ECG at the study centre or at their local paediatric cardiologist 6 months after RFCA. Further follow-up was scheduled at the discretion of the attending paediatric cardiologist. Patients with recurrent arrhythmic events, tachycardia, palpitations or anomalous ECG findings (e.g. atrioventricular block, prolonged AV-conduction time, ST-segment evaluation) either presented themselves or were referred to the study centre for re-evaluation and re-ablation if indicated. Observation time was defined as the time interval between RFCA and December 2012. However, to prevent overestimation of observation time, the maximum observation time was defined as the time between RFCA and the 19th birthday of patients who reached an age of 19 years before December 2012. Statistical analysis Statistical analysis was performed using SPSS© version 20.0 for Windows© (SPSS©, Chicago, IL, USA). Continuous variables are presented as median, minimum and maximum values, categorical variables as absolute frequencies and percentages. Comparisons between groups were analysed by chi-square or Fisher’s exact test for categorical variables. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated when applicable, and multivariate analyses using logistic regression were performed to determine independent influence of various risk factors. Significance level was
