Impact of curative ablation on pharmacologic management in children with reentrant supraventricular tachycardias

Background: The introduction of radiofrequency catheter ablation as a curative treatment option has led to a much better outlook for children with recurrent supraventricular reentrant tachycardias (SVT). This study sought to evaluate the impact of ablation on pharmacologic treatment of SVT. Methods: Two time periods were retrospectively compared with regard to number of episodes of SVT in different age groups, number of acute drug conversions of SVT, chronic antiarrhytmic drug treatments prescribed: in the first period (1989–1994) management of SVT was exclusively pharmalogical whereas during the second period (1995–2000) ablation was an option for patients aged 5 years or older. Results: The study included 88 pediatric patients with recurrent SVT, 40 in the first period, 48 in the latter. Of these, 16 children (all >5 years of age) had an ablation procedure during the second time period. In patients aged >5 years, the number of documented SVT fell from a mean of 3.7/patient to two episodes. The number of acute drug conversions of SVT decreased from a mean of 1.1/patient to 0.2 (p<0.05) during the second period. In the group of children aged >5 years chronic antiarrhythmic treatment was given during a mean of 15 months/patient in period one compared to 4.6 months (p<0.05) in the second period. Conclusion: In the current era with increasing use of ablation as first-line treatment in older children with recurrent SVT, acute as well as chronic pharmacologic intervention for SVT has become significantly less frequent.