Pediatric electrophysiology
DOI:
https://doi.org/10.13112/pc.1084Keywords:
ELECTROPHYSIOLOGY; HEART; CHILD; ARRHYTHMIAS, CARDIACAbstract
Electrophysiology has emerged as an important diagnostic and therapeutic method in the last three decades, often the first choice in the treatment of arrhythmias. In this procedure, catheter electrodes are used to enter the heart through central veins or arteries to determine the exact arrhythmogenic substrate and often to interrupt its activity by ablation.
The greatest step forward in reducing the amount of ionizing radiation in these procedures was the introduction of 3D mapping systems. These systems allow for the spatial placement of the catheter and the creation of a map of the heart's anatomy and electrical activity. The intracardiac electrogram is saved and the activation time can be compared with a reference point. It allows for the creation of an activation map that shows the way the signal propagates through the heart, which increases the precision of the work compared to procedures performed exclusively using X-ray radiation. This significantly reduces the patient's radiation exposure, which is especially important in childhood.
In Croatia, more than 2000 electrophysiological procedures are performed annually in all age groups, and almost 300.000 in Europe. In children, there were slightly more than 100 electrophysiological procedures performed in 2024. in our country.
This method of treatment achieves a permanent cure for arrhythmia, which is its greatest advantage compared to the only other option, drug treatment. While the effects of drugs are seen when patients take them regularly, there are no drugs that can definitively cure an arrhythmia. Since long-term use of drugs that have significant side effects is required, it is clear why electrophysiology, despite its risks, is increasingly used as the first line of treatment.
References
1. Clausen H, Theophilos T, Jachno K, Babl F. Arrhythmias of children in the emergency department: incidence, management and outcome. Arch Dis Child. 2010;95(Suppl 1):A42–A42. doi: 10.1136/adc.2009.172703.
2. Gilljam T, Jaeggi E, Gow RM. Neonatal supraventricular tachycardia: outcomes over a 27-year period at a single institution. Acta Paediatr. 2008;97(8):1035–9. doi: 10.1111/j.1651-2227.2008.00899.x.
3. Massin MM, Benatar A, Rondia G. Epidemiology and outcome of tachyarrhythmias in tertiary pediatric cardiac centers. Cardiology. 2008;111(3):191–6. doi: 10.1159/000112724.
4. Ghosh RM, Gates GJ, Walsh CA, Schiller MS, Pass RH, Ceresnak SR. The prevalence of arrhythmias, predictors for arrhythmias, and safety of exercise stress testing in children. Pediatr Cardiol. 2015;36(3):584–90. doi: 10.1007/s00246-015-1093-z.
5. Durrer D, Schoo L, Schuilenburg RM, Wellens HJ. The role of premature beats in the initiation and the termination of supraventricular tachycardia in the Wolff-Parkinson-White syndrome. Circulation. 1967;36(5):644–62. doi: 10.1161/01.CIR.36.5.644.
6. Wellens HJ. Value and limitations of programmed electrical stimulation of the heart in the study and treatment of tachycardias. Circulation. 1978;57(5):845–53. doi: 10.1161/01.CIR.57.5.845.
7. Olsson A, Darpö B, Bergfeldt L, Rosenqvist M. Frequency and long term follow up of valvar insufficiency caused by retrograde aortic radiofrequency catheter ablation procedures. Heart. 1999;81(3):292–6. doi: 10.1136/heart.81.3.292.
8. Clark J, Bockoven JR, Lane J, Patel CR, Smith G. Use of three-dimensional catheter guidance and trans-esophageal echocardiography to eliminate fluoroscopy in catheter ablation of left-sided accessory pathways. Pacing Clin Electrophysiol. 2008;31(3):283–9. doi: 10.1111/j.1540-8159.2007.01019.x.
9. Bigelow AM, Smith G, Clark JM. Catheter ablation without fluoroscopy: current techniques and future direction. J Atr Fibrillation. 2014;6(6):1066. doi: 10.4022/jafib.1066.
10. Jan M, Žižek D, Rupar K, et al. Fluoroless catheter ablation of various right and left sided supra-ventricular tachycardias in children and adolescents. Int J Cardiovasc Imaging. 2016;32(11):1609–16. doi: 10.1007/s10554-016-0997-7.
11. Miyamoto K, Kapa S, Mulpuru SK, et al. Outcome of combined cryo- and radiofrequency-catheter ablation in patients with supraventricular tachycardias. J Cardiovasc Electrophysiol. 2019;30(10):1960–6. doi: 10.1111/jce.14127.
12. Nakagawa H, Ikeda A, Yokoyama K, et al. Improvement in lesion formation with radiofrequency energy and utilization of alternate energy sources (cryoablation and pulsed field ablation) for ventricular arrhythmia ablation. Card Electrophysiol Clin. 2022;14(4):757–67. doi: 10.1016/j.ccep.2022.08.004.
13. Noten AME, Kammeraad JAE, Ramdat Misier NL, et al. Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation. Int J Cardiol Heart Vasc. 2021;37:100881. doi: 10.1016/j.ijcha.2021.100881.
14. Katritsis DG. Catheter ablation of atrioventricular nodal re-entrant tachycardia: facts and fiction. Arrhythm Electrophysiol Rev. 2018;7(4):230. doi: 10.15420/aer.2018.21.
15. Joseph JP, Rajappan K. Radiofrequency ablation of cardiac arrhythmias: past, present and future. QJM. 2012;105(4):303–14. doi: 10.1093/qjmed/hcr202.
16. Del Carpio Munoz F, Buescher TL, Asirvatham SJ. Three-dimensional mapping of cardiac arrhythmias: what do the colors really mean? Circ Arrhythm Electrophysiol. 2010;3(6):e6-11. doi: 10.1161/CIRCEP.110.957218.
17. Raatikainen MJP, Arnar DO, Merkely B,et al. A decade of information on the use of cardiac implantable electronic devices and interventional electrophysiological procedures in the European Society of Cardiology countries: 2017 report from the European Heart Rhythm Association. Europace. 2017;19(suppl_2):ii1–90. doi: 10.1093/europace/eux133.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Nikola Krmek

This work is licensed under a Creative Commons Attribution 4.0 International License.
By publishing in Paediatria Croatica, authors retain the copyright to their work and grant others the right to use, reproduce, and share their research articles in accordance with the Creative Commons Attribution License (CC BY 4.0), which allows others to distribute and build upon the work as long as they credit the author for the original creation.