Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: Comparison of early and recent eras

Introduction: To assess changes of success rate, fluoroscopy time, and complication rate for six supraventricular tachycardia pathways/mechanisms, data from the Pediatric Radiofrequency Catheter Ablation Registry were grouped into two eras (1991-1995; 1996-1999). Methods and Results: Data from the early era and the late era were compared using the Chi-square test for the outcomes of success rate and complication rate and using the Student's t-test for the outcome of mean fluoroscopy time. In the Registry as a whole, ablation failure rates fell from 9.6% in the early era to 4.8% in the recent era, a reduction of 50% overall. Improved success rates were found for posterior septal, right free-wall, and left free-wall pathways and for AV nodal reentry, whereas anterior septal pathways and atrial ectopic-focus tachycardia did not show improvement. Mean fluoroscopy time overall decreased 21% from 50.9 +/- 39.9 minutes to 40.1 +/- 35.1 minutes. Individually, the improvement in fluoroscopy time was found for all but the atrial ectopic-focus tachycardia mechanism. The complication rate decreased from 4.2% to 3.0%, with significant decreases for left free-wall and posterior septal pathways. Conclusion: Patient selection strategies to optimize radiofrequency ablation outcomes in children, which have been based on the previously published Registry data, should be reconsidered in light of these new, updated data. The lack of uniform improvement provides the impetus for further research and development of new approaches and technologic advances so that further improvement can be achieved.