ABSTRACT
Since initial reports in the late 1980s, catheter ablation has become accepted as the standard of care for most cardiac tachyarrhythmias. Significant technical developments have evolved, including cryoablation, electroanatomic and noncontact mapping, irrigated catheters, and several other novel technologies. While most of these innovations have been driven by applications to adults with various arrhythmogenic substrates, they have also been employed in young patients with similar success. Although technologies have progressed, one aspect which has remained static (or even regressed) is catheter size and utility in very young patients. There are several factors which are relevant to the lack of specific equipment for very young patients and perhaps some solutions that allow the use of standard adult catheters/equipment in modified applications. To put these issues into proper perspective, it is first necessary to discuss what is currently known about arrhythmias in very young patients and the outcomes of ablation, potential unique risks when ablation is performed in the immature myocardium, and potential limitations due to heart size and vascular capacity.
Catheter ablation procedures in infants and young children should remain limited to cases refractory to medical therapy. When necessary, these procedures can be performed successfully with a limited number of catheters, and RF application times should likely be limited to 50 degrees Celsius and 20 to 30 seconds’ duration in the very smallest children.
