Abstract 1793: Catheter Ablation in Critically Ill Pediatric and Congenital Heart Disease Patients
Introduction: The utility of catheter ablation (ABL) for tachycardia management in critically ill pediatric/congenital heart disease (CHD) patients has not been studied. We hypothesized ABL was safe and effective in this group, and assessed this by identifying short term outcomes and covariate factors.
Methods: Retrospective descriptive analysis of ABL performed during ICU admission at one institution between 01/96 and 10/08. Pts were excluded if admitted to ICU solely for peri-procedural monitoring or complication. Pts were grouped by presence of CHD. Outcomes were arrhythmia control at ICU discharge, complications and mortality.
Results: 93 ABL (5% of all ABLs) were performed in 71 pts. Median age was 4 (0 – 48) yrs. 38 pts (53%) had CHD, 30 (42%) normal anatomy (Nl) and 3 other. Clinical status, indication and outcome are presented in Table⇓. 58 pts (82%) had acute ABL success, with arrhythmia control at ICU discharge in 64 (90%) (Nl vs CHD, P=NS). Recurrence was seen in 17 pts (23%), and 11 pts (14%) had ABL complications, with 3 transient and 1 inadvertent permanent AV block. There were 5 deaths (7%), all non-arrhythmic in smaller, sicker patients (p<0.01), 3 (of 8) with Ebsteins anomaly.
Conclusions: Compared to published ABL outcomes, ICU pts had lower success and higher complication rates, but clinical utility of ABL was high. Nl pts had more LV dysfunction but trended to better outcomes. Mortality was associated with clinical instability and low weight. Ebstein’s disease represents a particular challenging group.