Radiofrequency catheter ablation of ventricular tachycardia in children and young adults with congenital heart disease

Abstract

Objectives: The aim of this study was to expand data on outcomes for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in young patients and to identify obstacles to success.

Background: Ablation of VT is performed infrequently in young patients. Published experience has been limited to case reports and small descriptive series.

Methods: A retrospective review of 97 consecutive VT ablation procedures involving 62 patients at a single institution from 1990 to 2003 was undertaken. All intention-to-treat procedures were analyzed.

Results: Mean age was 13.9 +/- 9.4 years. Procedures were categorized according to VT mechanism as follows: idiopathic right ventricle (n = 37); idiopathic left ventricle (n = 24); congenital heart disease (n = 20); or other structural disease (n = 16). Acute success was achieved in 58 (60%) of 97 procedures. Of the 39 failures, 33 were aborted cases due to inability to induce sufficient ectopy for mapping in 12, high-risk location near the His bundle or coronary artery in 11, unstable VT in 7, and anatomic obstacles in 3. Recurrence rate after acutely successful RFCA was 34% (20/58 procedures) at a mean follow-up of 3.8 +/- 2.0 years. Ultimately, long-term success was achieved in 38 (61%) of 62 patients after a mean of 1.6 +/- 0.9 procedures, with the highest success rate (87%) for idiopathic left ventricular tachycardia.

Conclusions: When analyzed on a strict intention-to-treat basis, a long-term success rate of 61% is observed with ablation of VT in young patients. Inability to induce stable VT for precision mapping and certain high-risk VT locations can be significant obstacles to success.