The Most Common Site of Success and Its Predictors in Radiofrequency Catheter Ablation of the Slow Atrioventricular Nodal Pathway in Children

Background: Locating ablation targets on the slow pathway in children as one would in adults may not accommodate the dimensional changes of Koch's triangle that occur with heart growth. We investigated the most common site of success and the effect of a variety of variables on the outcome of sl...

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Published in:Pacing and clinical electrophysiology 2008-10, Vol.31 (10), p.1300-1306
Main Authors: HWANG, HAW-KWEI, WOLFF, GRACE S., SUN, FANG-JU, YOUNG, MING-LON
Format: Article
Language:English
Subjects:
Adolescent
Atrioventricular Node - surgery
AV nodal reentrant tachycardia
catheter ablation
Catheter Ablation - methods
Child
Child, Preschool
children
Female
Humans
Male
Tachycardia, Atrioventricular Nodal Reentry - diagnosis
Tachycardia, Atrioventricular Nodal Reentry - surgery
Treatment Outcome
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Summary:Background: Locating ablation targets on the slow pathway in children as one would in adults may not accommodate the dimensional changes of Koch's triangle that occur with heart growth. We investigated the most common site of success and the effect of a variety of variables on the outcome of slow pathway ablation in children. Methods: A total of 116 patients (ages 4–16 years) with structurally normal hearts underwent radiofrequency ablation of either the antegrade or the retrograde slow pathway. Ablation sites were divided into eight regions (A1, A2, M1, M2, P1, P2, CS1, and CS2) at the septal tricuspid annulus. Results: Ablation was successful in 112 (97%) children. The most common successful ablation sites were at the P1 region. The less the patient weighed, the more posteriorly the successful site was located (P = 0.023, OR 0.970, 95% CI 0.946–0.996), and the more likely the slow pathway was eliminated rather than modified: median weight was 46.7 kg (range, 14.5–94.3 kg) in the eliminated group and 56.5 kg (range, 20–82.6 kg) in the modified group (P = 0.021, OR 1.039, 95% CI 1.006–1.073). Conclusions: The most common site of success for slow pathway ablation in children is at the P1 region of the tricuspid annulus. The successful sites in lighter children are more posteriorly located. Weight is also a predictor of whether the slow pathway is eliminated or only modified.
ISSN:0147-8389
1540-8159
DOI:10.1111/j.1540-8159.2008.01181.x