A single-center long-term analysis of catheter ablation of tachyarrhythmias in children and adolescents

Background Tachyarrhythmias in children and adolescents represent a heterogeneous group of rhythm disorders affecting morbidity and quality of life. While extensive data exist on various ablation procedures for tachyarrhythmias in adults, the amount of comparable data in children and adolescents remains limited. Methods and Results This retrospective single-center study enrolled 390 patients (48.7% male, mean age 14.3 years) under the age of 18 from 2006 to 2022 undergoing an invasive electrophysiologic examination for predicted or documented tachyarrhythmias. Data were collected from procedural records and from in- and outpatient follow-up by collaborating specialists, extending up to 16 years post-procedure. Depending on patients age and preference procedures were performed under local anesthesia, conscious sedation or general anesthesia. Non-inducibility at the end of the procedure was the criterion for success. Congenital heart disease, mainly tetralogy of Fallot, was present in 6.2%. Symptomatic or documented tachycardia was the major indication (92%). The main arrhythmia mechanisms were AVRT (50.3%) and AVNRT (33.3%). In total, the procedural success was high (92%). Reduced success rates were observed in congenital heart disease and patients with ventricular tachycardia. Major complications were rare (0.77%) and no fatality occurred. 15% of patients experienced an arrhythmia recurrence during follow-up. In accordance, this was more common in ventricular arrhythmias and congenital heart disease. Conclusion These observations highlight the safety and efficacy of catheter ablation in children and adolescents. While ablation of AVNRT and AVRT presented excellent outcomes, ectopic atrial and ventricular arrhythmias, as well as congenital heart disease, were associated with lower success and higher recurrence rates.