The issue of performing radiofrequency catheter ablation (RFCA) in infants and young children is controversial. This study examines one center's experience with this procedure, concentrating on indications and outcomes. Since 1991, 33 pts have undergone RFCA who weighed less than 35 pounds or were less than 3.5 years at the time of their procedure. This pt population represented 7.6% of all RFCA procedures performed at the Medical University of South Carolina. Thirteen of these 33 pts were less than one year at the time of their procedure. The average age of this group was 15 months (1·42 months), and the average weight was 8 kg (3.5-16 kg). The indications for RFCA procedures included 4 pts with life-threatening events, 26 pts who had failed Class I and/or Class III therapy, and 3 pts who had only failed digoxin and propranolol. Twenty-nine pts had reentrant supraventricular tachycardia. Three pts had atrial ectopic tachycardia, and one pt had junctional ectopic tachycardia. These 33 pts underwent a total of 39 procedures, all except one being performed via the atrial approach. Follow-up ranges between 2 months and 4 years. Twenty-seven of 33 pts had totally successful procedures (no medications, no tachycardia - 82%). Four out of 33 pts had a modified success, needing digoxin or propranolol for tachycardia control post procedure, and 2 pts were ablation failures who subsequently had successful surgical ablations. Complications were limited to a 13-month old with intermittent, second-degree atrioventricular block who has no need for pacemaker therapy. There has been no mortality.

Conclusions: RFCA in young children and infants can be performed with a success rate similar to that achieved in the general pediatric population. Complication rates are low and, with intermediate follow-up, there is little morbidity. Although indications are controversial, we believe that there is a place for this therapy in the management of recalcitrant supraventricular tachycardia in the infant or young child.