Radiofrequency catheter ablation of ventricular tachycardia in children and young adults with congenital heart disease

The aim of this study was to expand data on outcomes for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in young patients and to identify obstacles to success. Ablation of VT is performed infrequently in young patients. Published experience has been limited to case reports and small descriptive series. A retrospective review of 97 consecutive VT ablation procedures involving 62 patients at a single institution from 1990 to 2003 was undertaken. All intention-to-treat procedures were analyzed. Mean age was 13.9 ± 9.4 years. Procedures were categorized according to VT mechanism as follows: idiopathic right ventricle (n = 37); idiopathic left ventricle (n = 24); congenital heart disease (n = 20); or other structural disease (n = 16). Acute success was achieved in 58 (60%) of 97 procedures. Of the 39 failures, 33 were aborted cases due to inability to induce sufficient ectopy for mapping in 12, high-risk location near the His bundle or coronary artery in 11, unstable VT in 7, and anatomic obstacles in 3. Recurrence rate after acutely successful RFCA was 34% (20/58 procedures) at a mean follow-up of 3.8 ± 2.0 years. Ultimately, long-term success was achieved in 38 (61%) of 62 patients after a mean of 1.6 ± 0.9 procedures, with the highest success rate (87%) for idiopathic left ventricular tachycardia. When analyzed on a strict intention-to-treat basis, a long-term success rate of 61% is observed with ablation of VT in young patients. Inability to induce stable VT for precision mapping and certain high-risk VT locations can be significant obstacles to success.