Drugs and ablation in the treatment of supraventricular tachyarrhythmias in children.

The vast majority of children who have symptoms (ie, cardiac failure, palpitations, dizziness) due to supraventricular tachycardias are successfully managed by medical treatment. Antiarrhythmic drug therapy may be complicated by side effects or become ineffective so that radiofrequency catheter ablation, which destroys the myocardial structure responsible for arrhythmias, can now offer an attractive option to lifelong drug therapy. Immediate results for supraventricular tachycardias due to a reentry mechanism or to an atrial ectopic focus are good, with a success rate over 80% and rare immediate complications. However, the long-term sequelae of the procedure on the growing heart have not been established and the risk of subsequent atrial and ventricular arrhythmias must be considered in young patients. For this reason, I believe that today, radiofrequency ablation should be reserved for young patients who have life-threatening symptoms or who have arrhythmias that are refractory to medical treatment, and for older patients who will need a lifelong drug therapy.