Outcomes of a Simplified Two-Catheter Approach for Catheter Ablation of SVT in Pediatric Patients.

BACKGROUND

Catheter ablations are an established treatment for supraventricular tachycardia (SVT) in pediatric patients with high success and low complication rates typically. This study evaluated the procedural outcomes, safety, and recurrence rates of pediatric patients undergoing SVT ablation using a two-catheter approach.

METHODS

A retrospective review was performed of 150 pediatric patients who underwent electrophysiology studies and catheter ablation for SVT. All patients were younger than 21 years, with arrhythmia mechanisms including atrioventricular nodal reentrant tachycardia (AVNRT), ectopic atrial tachycardia (EAT), atrial flutter, and other accessory pathway-mediated tachycardias. All electrophysiology (EP) studies and catheter ablations were performed using a two-catheter access approach at the University of California at Davis by a sole operator with typically just a catheter in the coronary sinus and a second linear catheter (right atrial/ ventricular/ His) to start. All patients had follow-up of one year or if recurrence than 1 year from subsequent ablation.

RESULTS

Acute procedural success was achieved in all patients. The median age at the time of ablation was 13 years (IQR: 8-16 years). The median weight and height were 53.9 kg (IQR: 34.6-67.6 kg) and 157.3 cm (IQR: 137-170 cm), respectively. No intraprocedural complications were observed, including vascular access complications. Additionally, no postprocedural complications occurred, including pericardial effusion, cardiac tamponade, air embolism, thrombus formation, or heart block. Two patients experienced arrhythmia recurrence within 12 months of follow-up, corresponding to a recurrence rate of 1.3% and an overall success rate of 98.7%. Recurrence occurred in one patient with a Mahaim pathway and one patient with a left posterolateral accessory pathway.

CONCLUSION

A two-catheter access approach may be safely performed with good short-and medium-term outcomes in pediatric patients.