Testing efficacy in determination of recurrent supraventricular tachycardia among subjectively symptomatic children following "successful" ablation.

ABSTRACT

BACKGROUND: Supraventricular tachycardia (SVT) in children can be successfully terminated using catheter ablation techniques; however, chronic, true success may be less. Sensed tachycardia (ST) is common following ablation and the differentiation from true arrhythmia recurrences can be challenging. METHODS: Records of all patients ≤ 18 years who underwent successful ablation for simple forms of SVT and followed-up for at least a year between 2002 and 2012 were reviewed. Patients with congenital heart disease, atrial muscle tachycardia, and associated ventricular tachycardia were excluded. The diagnostic utility of commonly performed tests was assessed. RESULTS: Among the 205 eligible subjects, 202 underwent successful ablation (98.5%), of who five were lost to follow-up before 1 year. The early success rate (6 weeks postablation) and mid-term success rate (1 year postablation) were high (97.5% and 87.4%, respectively) whereas the chronic success (5 years postablation) was only 75%. Although true arrhythmia recurrence was significantly higher in the young (mean 11.5 years vs 13.5 years, P = 0.03) and males (P = 0.02), the presence of diffuse, right-sided fibers was the only independent predictor of true recurrence (odds ratio = 2.7, P = 0.03, 95% confidence interval 1.1, 6.8). Significant ST was reported by 111 patients (56%). The 30-day ambulatory event monitor had the highest sensitivity (71%) when compared to exercise test (19%) and electrocardiogram (24%) in identifying true arrhythmia recurrence. CONCLUSIONS: Acute and early success may not guarantee chronic ablation success. Postablation, symptomatic patients can be most effectively evaluated using ambulatory event monitoring; however, true recurrence may still be missed and requires closer monitoring.