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Radiofrequency catheter ablation for supraventricular tachycardia in a paediatric population: characteristics of tachycardia mechanisms in a subpopulation with early onset

Published online by Cambridge University Press:  25 September 2020

Yamina Schibli ,
Matthias Gass ,
Florian Berger  and
Christian Balmer
Yamina Schibli
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
Matthias Gass
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland Lake Constance Heart Center, Luisenstr. 9, 78464 Constance, Germany
Florian Berger
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
Christian Balmer*
Affiliation:
Paediatric Cardiology, Paediatric Heart Center, Department of Surgery, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
*
Author for correspondence: Christian Balmer MD, University Children’s Hospital, Steinwiesstrasse 75, 8032 Zürich, Switzerland. Tel: +41 44 266 73 79; Fax +41 44 266 79 81. E-mail: christian.balmer@kispi.uzh.ch
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Abstract

Background:

In children, the first episode of supraventricular tachycardia occurs at various ages. The aim of this study is to describe age-specific tachycardia mechanisms, clinical findings, and outcome in a contemporary cohort of paediatric patients with supraventricular tachycardia.

Methods:

Retrospective analysis of 531 consecutive patients with structurally normal hearts under the age of 18 years who underwent invasive electrophysiological study for supraventricular tachycardia. The study population was divided into two groups, early-onset group (n = 57) and late-onset group (n = 474), according to the age of the occurrence of the first tachycardia before or after the age of 12 months.

Results:

Accessory pathway-mediated tachycardia was more common (82.5 versus 50.1%, p < 0.001) and the proportion of left-sided accessory pathways was more pronounced (74.5 versus 53.7%, p = 0.01) in the early-onset group than in the late-onset group. The antegrade and retrograde refractory periods of the accessory pathways were similar in both groups, but pre-excitation was more common in the early-onset group (50.9 versus 31.9%, p = 0.007). Typical atrioventricular nodal re-entrant tachycardia was more common (36.7 versus 7.0%, p < 0.001) in the late-onset group. There was no difference among the two groups regarding overall outcome.

Conclusion:

Accessory pathway-mediated re-entrant tachycardia is the most common mechanism of recurrent supraventricular tachycardia in infants with structurally normal hearts who are later referred to an electrophysiological study. These pathways often cause pre-excitation and tend to be located on the left side whereas their refractory period is not different from that of patients with late-onset tachycardia.

Keywords

Supraventricular tachycardiachildreninfantaccessory pathwayelectrophysiological studyradiofrequency catheter ablation

Information

Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 10 , October 2020 , pp. 1383 - 1388
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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