Perspectives in interventional electrophysiology in children and those with congenital heart disease: electrophysiology in children

Abstract

Recent developments in paediatric pacing and ablation of arrhythmia substrate have been characterised by adoption and modification of techniques used in adults. Infants, small children and those of all ages with congenital heart disease are a patient group with a higher risk profile needing a special approach. Current success rates for catheter ablation are high and major complication rates are low. Important issues with respect to long-term outcome include questions about coronary injury, long-term effects of radiation exposure and late recurrence. Non-fluoroscopic electro-anatomical mapping systems (3D systems), cryo-ablation and remote navigation are techniques recently improved such that it is possible to potentially reduce fluoroscopy and complications. Pacing in young children and congenital heart disease often warrants an epicardial approach to avoid embolism, venous occlusion and lead failure related to growth. Defibrillator and resynchronisation therapy are increasingly important tools to reduce mortality, although the indications are not as clear as in adult patients without congenital heart disease.