Pediatric/Adult Congenital Heart Disease -> Pediatric Cardiology D-MP08 - Pediatric and Arrhythmia & Device Management (ID 12) Moderated ePoster

D-MP08-06 - Contemporary Outcomes Of Catheter Ablation For Focal Ventricular Tachycardia In Pediatrics (ID 820)

Abstract

Background: Data regarding pediatric focal ventricular tachycardia (VT) ablation are limited.
Objective: Report outcomes and predictors of success for focal VT ablation in pediatric pts.
Methods: Single-center retrospective study of pts aged < 21 yrs undergoing ablation for focal VT and/or high-density ectopic beats between 2006-2019.
Results: Total of 92 consecutive patients (47% females) underwent 122 procedures at mean age 13+5.5 yrs. The focus had outflow tract (OT) origin in 54 pts (RVOT in 32, LVOT in 22). The procedure was acutely successful in 82% with active mappable VT in a safe location. Pre-procedure characteristics (demographics, % ectopy or repetitive ectopy on Holter) did not predict mappable VT, nor did VT location or sedation method during the procedure. Ketamine sedation appeared promising but did not reach statistical significance due to limited pt number. Among pts with mappable VT in safe location, acute success was predicted by OT location (p <0.01). Recurrence was observed after 26 procedures, and was associated with need for empiric ablation due to poor end-point, pace-mapping without activation mapping, and LV body focus (p < 0.01).
Conclusion: Focal VT ablation is generally effective in children, especially those with OT origin and ectopy allowing activation mapping. We have yet to identify clear clinical or procedural features that predict active VT for mapping. Preliminary experience with ketamine appears promising, and deserves further study.
Table - 1: Sedation Method (* undetermined in 4 patients)
No. of proceduresspontaenous InducibilityInducible with pacing +/- catecholaminesInduciblep-value
All11870 (59%)33 (38%)103 (87%)p-value
General Anesthesia7643 (57%)22 (29%)65 (86%)0.4
Propofol2821 (75%)5 (18%)26 (93%)0.2
Ketamine52 (40%)3 (60%)5 (100%)0.3
Mixed21 (50%)0 (0%)1 (50%)0.2
None73 (43%)3 (43%)6 (86%)0.3
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