Contemporary Outcomes of Catheter Ablation for Supraventricular Tachycardia in Children
Charles Christian Anderson, MD
Providence Center for Congenital Heart Disease
Sacred Heart Children’s Hospital
Two recent large multicenter studies featuring outcomes data for catheter ablation of supraventricular tachycardia (SVT) in children demonstrate superior outcomes in comparison to past studies. SVT in school age children is often life-altering, but rarely life-threatening. Accepted indications for catheter ablation of SVT in the pediatric population are generally considered to include failure of medication to control SVT, SVT causing ventricular dysfunction or cardiomyopathy, symptomatic Wolff-Parkinson-White syndrome, and electively for any child 5 years of age or older. The Prospective Assessment of Pediatric Catheter Ablation (PAPCA), a multicenter series of 481 patients published in 2002, set the stage for creating these enduring guidelines for use of catheter ablation to treat SVT in children, with acute procedural success rates ranging from 91-99%, depending on the type and location of SVT, and low rates of serious complications (1.6%). However, fluoroscopy exposure times were often long, with a mean fluoroscopy time of 38 minutes. The pediatric electrophysiology (EP) community regarded this latter piece of data with concern, as fluoroscopy is a form of ionizing radiation that could have potentially deleterious effects on our patients and our EP laboratory staff as well.
Pediatric EP physicians, including 2 Washington state physicians, took a leadership role in efforts to reduce fluoroscopy exposure to our patients and staff by maximizing techniques to reduce use of fluoroscopy, including use of newer 3D mapping technologies that allow for nonfluoroscopic imaging of the heart and the catheters used in ablation procedures. In one 2019 study led by Dr. Stephen Seslar of Seattle Children’s Hospital, results of the contemporary Multicenter Pediatric and Congenital EP Quality Initiative (MAP-IT) demonstrated equivalent success to PAPCA in a series of just over 1400 patients, but with reduced incidence of serious complications (0.4%), and significantly decreased mean fluoroscopy exposure 7 minutes)1. A second study reporting outcomes of the Catheter Ablation with Reduction or Elimination of Fluoroscopy (CAREFL) registry again reports equivalent procedural success in a series of 786 patients, with a rate of serious complications of 0.3% and mean fluoroscopy exposure of 1.2 minutes2.
While there is always room for improvement, these more contemporary studies validate the use of catheter ablation as a safe and effective treatment for SVT in our pediatric patients, with progressively reduced fluoroscopy use for imaging, making the EP lab a safer environment both for our patients and staff.
- Dubin, AM, Jorgensen NW, Radbill AE, Bradley DJ, Silva JN, Tsao S, Kanter RJ, Tanel RE, Trivedi B, Young M-L, Pflaumer A, McCormack J, Seslar SP. What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous ablation registries. Heart Rhythm 2019; 16: 57-63.
- Anderson CC, Akdeniz C, Bradley DJ, Breedlove K, Dick M, LaPage MJ, Martinez AR, McNinch NL, Moore JP, Papagiannis J, Razminia M, Shannon KM, Shauver LM, Tuczu V, Clark JM. Acute outcomes of three-dimensional mapping for fluoroscopy reduction in pediatric catheter ablation for supraventricular tachycardia. Submitted for publication