Electrophysiological Characteristics and Outcomes of Radiofrequency Catheter Ablation of Atrial Flutter in Children with
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ORIGINAL ARTICLE
Electrophysiological Characteristics and Outcomes of Radiofrequency Catheter Ablation of Atrial Flutter in Children with or Without Congenital Heart Disease He Jiang1 · Xiao‑Mei Li1 · Yi Zhang1 · Hai‑Yan Ge1 · Hai‑Ju Liu1 · Mei‑Ting Li1 Received: 13 March 2020 / Accepted: 25 June 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract There are scarce studies on radiofrequency catheter ablation (RFCA) of atrial flutter (AFL) in the pediatric population. This study therefore aimed to investigate the clinical features and RFCA of AFL in children with or without congenital heart disease. Data from 72 consecutive children (44 males; mean age, 6.1 ± 3.8 [0.9–15.0] years; and mean weight, 23.6 ± 13.9 [8.1–72.0] kg) undergoing RFCA for AFL from 2009 to 2019 were retrospectively reviewed. Thirty-three patients had normal cardiac structure and 39 had congenital heart disease (CHD) of whom 29 had undergone surgical repair and developed AFL at a mean of 3.1 ± 2.5 years later. Fifty-nine patients (84%) presented with persistent AFL. Five patients (7%) had cardiac dysfunction with LVEF of 30–48%, which normalized after ablation. Overall, acute success rate of ablation was 99% and recurrence rate was 18% at 0.5–10 years of follow-up. No procedure-related complications were identified. All 33 patients with normal cardiac structure had cavotricuspid isthmus (CTI)-dependent AFL. Among patients who had undergone corrective surgery for CHD, 15 (52%) had CTI-dependent AFL, 4 (14%) had surgical incisional scar reentrant AFL and the remaining 10 (34%) had both CTI-dependent and scar reentrant AFL. Success rate (100% vs. 97%, P = 1.0000) and recurrence rate (21% vs. 16%, P = 0.7008) were similar between patients with and without CHD. Overall, sick sinus syndrome (SSS) was found in 42% (30/72) of patients with AFL, with an incidence of 39% (13/33) among patients with normal cardiac structure and 59% (17/29) among those who underwent surgery for congenital defects. Permanent pacemakers (PM) were implanted in 53% (16/30) of patients with SSS after ablation. RFCA therefore appeared efficacious and safe for treatment of pediatric AFL. The mechanisms underlying AFL after corrective surgery for CHD are complex, including CTI-dependent macro-reentrant, scar reentrant, or a combination of both. SSS is not rare among pediatric AFL cases, with approximately half of patients needing PM implantation. Keywords Atrial flutter · Pediatric · Ablation · Congenital heart disease · Sick sinus syndrome
Introduction Atrial flutter (AFL) is a rare tachyarrhythmia in children with normal cardiac structure, untreated congenital heart disease (CHD) or after corrective surgery of CHD [1]. AFL is a major cause of death after corrective surgery of CHD [2]. Some AFL patients have concealed sick sinus syndrome (SSS) which might lead to misdiagnosis and improper
treatment [3]. During the past 20 years, therapeutic options for pediatric AFL have evolved from pharmacotherapy to radiofrequency catheter ablation (RFCA) [4]
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