Is routine echocardiography valuable after uncomplicated catheter ablation in children?

Abstract

We determined the clinical value of routine transthoracic echocardiography performed after catheter ablation of supraventricular tachyarrhythmias in children. Between April 1996 and December 2003, 253 children, of whom 135 male, with the overall group having a median age of 9, ranging from 0.1 to 19 years, underwent 280 uncomplicated radiofrequency catheter ablation procedures for supraventricular tachyarrhythmias at three institutions. In every child, transthoracic Doppler echocardiography was performed before and after the procedure. The pre-ablation transthoracic echocardiograms were normal in all, and this was one of the criterions for inclusion. The post-ablation echocardiogram showed a disorder in four asymptomatic patients. In one patient, with focal atrial tachycardia, ablated via a retrograde aortic approach, there was mild aortic valvar insufficiency. This had resolved 6 months later. Pericardial effusions developed in 3 other children. In 2 the effusions resolved spontaneously but 1 patient required pericardial drainage. This same patient also developed clinically asymptomatic mild aortic insufficiency, which resolved spontaneously within 6 months. Routine echocardiography after uncomplicated catheter ablation procedures is of clinical value, and is especially indicated when a retrograde aortic approach has been used.

Radiofrequency catheter ablation can be performed with high success rates and very low complication rates in children and adolescents

“…There was a very low complication rate of only 3% in our study cohort, which is comparable or even lower than reported by earlier studies on RFCA in children (3,4,14,15,18,24,27). As RFCA was performed by a team of paediatric and adult electrophysiologists, the experience of experts from both specialties might have contributed to the very low incidence of complications.…”

“…However, as the study cohort consisted of very few young children, the risk of AV block in this subgroup might be considerably higher. In comparison, cryoablation in children is associated with a very low overall risk for complications and only transient AV block, which usually resolves during defrosting . The potential recovery of tissue, and achieving a more stable position of the ablation catheter via freezing, are especially valuable in very young children and cases when the ablation catheter is closely positioned to the bundle of His.…”

Speckle tracking derived left and right ventricular strain, strain rate and

“…Routine echocardiography is highly recommended when a retrograde aortic approach has been used. 13 However; previous clinical and experimental studies have provided evidence that postprocedural expansion of myocardial radiofrequency lesions can occurr. 14 For example, in an experimental study, using young lambs, myocardial scar dimensions were reported to increase in a time-dependent manner up to 9 months from 5.3(0.5) to 8.7(0.7) mm in the atrium tissue and from 5.9(0.8) to 10.1(0.7) mm in the ventricular tissue after radiofrequency ablation.…”