Radiofrequency catheter ablation for supraventricular tachycardia. Should it be used in infants and small children?

C atheter ablation for nonpharmacological management of pediatric patients with tachyarrhythmias has evolved during the past approximately 10 years. Direct-current energy ablation was initially used in some patients with drug-refractory, life-threatening tachyarrhythmias such as junctional ectopic-focus tachycardia and also for some children with left ventricular dysfunction due to incessant tachycardias (eg, the permanent form ofjunctional reciprocating supraventricular tachycardia and atrial ectopic-focus tachycardia.12 The extensive lesions and less-than-ideal results from direct-current energy prompted research and development of alternative energy sources that led quickly to clinical application of radiofrequency energy ablation of tachyarrhythmias in adults in the late 1980s. This apparently safer and more successful technique revolutionized the treatment of not only adults but also children and adolescents with supraventricular tachycardia in the 1990s.3-11 The 1992 report of ventricular tachycardia and sudden death during late follow-up of pediatric patients who had undergone direct-current ablation emphasizes the dangers of the direct-current ablation method but also serves as a warning against premature acceptance of any ablation technique because adverse effects may be detected only during late follow-up.12