Catheter ablation in children and patients with congenital heart disease: Review of 1021 procedures at a high-volume single center in Japan

Abstract

Background: Although pediatric catheter ablation therapy has often been described, few reports on outcomes in a large series of patients at a single center are available.

Objective: The purpose of this study was to evaluate arrhythmia substrates, outcomes, and complications of catheter ablation in children and patients with congenital heart disease (CHD) performed at a single center.

Methods: We retrospectively analyzed all pediatric patients <18 years and patients of all ages with CHD who underwent ablation therapy between June 2006 and May 2018.

Results: A total of 1021 ablation procedures were performed in 877 patients (median age 12.5 years; range 2 months to 67 years). This cohort included 152 CHD patients, 90 small patients (<15 kg), and 14 infants (<1 year). The most frequent indication was Wolff-Parkinson-White pattern (WPW) (n = 287 [32.7%]). Of the 55 patients with asymptomatic WPW, 40 patients (72.7%) had retrograde accessory pathway conduction. Overall success and recurrence rates were 93.5% and 17.3%, respectively. Small patients and CHD patients had lower success rates. No deaths occurred. Serious complications occurred in 5 patients.

Conclusion: Catheter ablation is safe and effective for treatment of arrhythmia in pediatric and CHD patients. However, ablation was less successful in small patients and CHD patients. The risk of complications was similar to those previously reported for catheter ablation in pediatric, CHD, and adult patients.

Keywords: Ablation; Adult congenital heart disease; Asymptomatic Wolff-Parkinson-White syndrome; Children; Cryoablation.