Clinical Profile and Outcomes of Electrophysiological Study and Radiofrequency Catheter Ablation in Pediatric and Adolescent Arrhythmias: A Single-center Experience

Background: Cardiac arrhythmias in children and adolescents are an important clinical concern, often leading to recurrent symptoms, repeated hospital visits, and a considerable impact on daily life. Although antiarrhythmic medications are commonly used, their long-term use is frequently limited by incomplete symptom control, side effects, and challenges with adherence. Over the last few decades, electrophysiological study (EPS) with radiofrequency catheter ablation (RFA) has increasingly become a definitive and reliable treatment option for many pediatric arrhythmias. Objective: The present study was conducted to examine the clinical characteristics, procedural details, and outcomes of EPS and RFA in patients aged 3–20 years treated at a tertiary care center in Jaipur. Methodology: We performed a retrospective review of 70 consecutive patients (mean age: 15.2 ± 3.5 years; 79% of males) who underwent EPS with or without RFA between March 2019 and September 2025. The study population included patients with a range of supraventricular and ventricular arrhythmias. Antiarrhythmic medications were stopped at least four half-lives before the procedure wherever applicable. Procedural success, complications, and recurrence during follow-up were evaluated. Results: Of the 70 patients who underwent EPS, tachycardia could not be induced in 7 patients (10%). Among those with inducible arrhythmias, the most frequent diagnosis was atrioventricular nodal reentrant tachycardia seen in 22 patients (32%), followed by Wolff–Parkinson–White syndrome in 20 patients (29%) and concealed accessory pathways in 10 patients (15%). Fascicular ventricular tachycardia was identified in 3 patients (4.5%), while other arrhythmias constituted a smaller proportion. RFA was performed in 62 patients, with a mean power delivery of 50 W and an average fluoroscopy time of 10.8 min. Acute procedural success was achieved in all patients undergoing ablation. During follow-up, recurrence was noted in only one patient with atrial flutter. No major procedural complications were observed. Conclusions: Our experience suggests that EPS and RFA are highly effective and safe in pediatric and adolescent patients. The procedures demonstrated excellent success rates, minimal complications, and very low recurrence during follow-up. These findings support the early consideration of catheter ablation as a definitive therapeutic option in young patients with recurrent symptomatic arrhythmias.