Congenital heart disease
Safety and Results of Cryoablation in Patients <5 Years Old and/or <15 Kilograms

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Current recommendations discourage elective radiofrequency ablation in patients <5 years old and/or weighing <15 kg, primarily because of the greater complication rate. To describe the current use, complications, and immediate outcomes of cryoablation in this patient population, a multicenter retrospective review of all patients <5 years old and/or weighing <15 kg who were treated with cryoablation for arrhythmia was performed. Eleven centers contributed data for 68 procedures on 61 patients. Of those, 34% were elective and 24% (n = 16) were both cryoablation and radiofrequency ablation. The median age and weight at ablation was 3.5 years (range 8 days to 9.9 years) and 15.2 kg (range 2.3 to 23), respectively. Congenital heart disease was present in 23% of the patients. The immediate success rate of cryoablation alone was 74%. No major complications occurred with cryoablation only; however, 2 of the 16 patients who underwent cryoablation and radiofrequency ablation had major complications. Of the 50 patients receiving cryoablation, 8 (16%) had variable degrees of transient atrioventricular block. The recurrence rate was 20% after cryoablation and 30% after cryoablation plus radiofrequency ablation. In conclusion, cryoablation appears to have a high safety profile in these patients. Compared to older and larger patients, the efficacy of cryoablation in this small, young population was lower and the recurrence rates were higher. Cryoablation's effect on the coronary arteries has not been fully elucidated and requires additional research.

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Methods

The present study was an international multicenter retrospective review of cryoablation in infants and children <5 years old and/or weighing <15 kg at the ablation procedure, including those in whom cryoablation was unsuccessful and RF was then used. Members of the Pediatric and Congenital Electrophysiology Society retrospectively collected data from the existing patient records at each of their respective institutions. The data were submitted to the primary investigators for analysis. All

Results

Eleven centers participated, contributing data on a total of 68 procedures performed on 61 patients. The diagnosis at initial presentation is listed in Table 1. Congenital heart disease was present in 14 (23%) of the 61 patients. Of the 61 patients, 4 had undergone a previous heart operation (3 atriotomies and 1 ventriculotomy). A total of 10 patients (16%) had signs of congestive heart failure before the ablation procedure—8 of these were in incessant tachycardia (5 with PJRT and 3 with focal

Discussion

The present study revealed several important findings. First, the use of cryoablation in this young, small patient population resulted in no major complications. Second, major complications occurred when small or young patients intended to be treated with cryoablation are converted to treatment with RF energy. Finally, surveillance for coronary artery damage in these patients was not routine and the risk of coronary artery injury was not assessable.

In the present study, no major complications

Acknowledgment

Thank you to Lacey Henry, Children's Hospital Denver, Nancy Chiesa, RN, UCSF Children's Hospital, and Mary Sokoloski, MD, Holtz Children's Hospital, for your assistance in data collection.

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