Management of Pediatric Tachyarrhythmias on Mechanical Support
Background—Pediatric patients with persistent arrhythmias may require mechanical cardiopulmonary support. We sought to classify the population, spectrum and success of current treatment strategies.
Methods and Results—A multicenter retrospective chart review was undertaken at 11 sites. Inclusion criteria were: 1) patients <21 years, 2) initiation of mechanical support for a primary diagnosis of arrhythmias, and 3) actively treated on mechanical support. 39 patients were identified, median age of 5.5 months and median weight of 6 kg. 69% of patients were cannulated for supraventricular tachycardia (SVT) with a median rate of 230 bpm. 90% of patients were supported with extracorporeal membrane oxygenation (ECMO) for an average of 5 days. The remaining 10% were supported with ventricular assist devices (VAD) for an average of 38 (20-60) days. 95% of patients were treated with antiarrhythmics, with 43% requiring >1 antiarrhythmic. Amiodarone was the most frequently used medication alone or in combination. 33% patients underwent electrophysiology study (EPS)/transcatheter ablation. Radiofrequency (RF) ablation was successful in 9 patients on full flow ECMO with 3 RF-failures/conversion to cryoablation. 1 patient underwent primary cryoablation. 15% of complications were related to EPS/ablation. At follow-up, 23 patients were alive, 8 expired and 8 transplanted.
Conclusions—Younger patients were more likely to require support in the presented population. Most patients were treated with antiarrhythmics and one-third required EPS/ablation. RF ablation is feasible without altering ECMO flows. There was a low frequency of acute adverse events in patients undergoing EPS/ablation while on ECMO.
- Received September 7, 2013.
- Revision received May 27, 2014.
- Accepted June 2, 2014.