Pediatric Cardiac Electrophysiology

Abstract

The rapid development of invasive cardiac electrophysi ologic procedures, including the insertion of rate-responsive pacemakers, radiofrequency catheter ablation (RFA), and the implantation of cardiac defibrillators has given pediatric cardiac electrophysiologists better techniques to treat in fants and children with arrhythmias. Expertise on the basic pathophysiologic mechanisms of arrhythmias is a requisite in performing invasive intracardiac electrophysiologic pro cedures. Techniques for invasive cardiac electrophysiologic procedures (EPS) in pediatric patients are similar to those for diagnostic cardiac catheterization. The choice of anes thesia is determined by institutional preference, patient's age, anticipated sites of intravascular access, and type of procedure. The goal is to avoid agents that depress myocar dial contractility or affect cardiac conduction or refractori ness. EPS equipment includes multielectrode catheters, a multichannel recording system, an electrical stimulator, and a fluoroscopy unit. EPS require the ability to induce, termi nate, and modify cardiac arrhythmias. The objectives of the EPS include definition of the mechanisms of observed and induced cardiac arrhythmias, determination of risk for sudden cardiac arrhythmic death, investigation of antiar rhythmic drug efficacy, and ablation of tachyarrhythmia sub strates. This is accomplished by evaluating electrophysi ologic properties, such as automaticity, conduction, and refractoriness; by initiating and terminating tachycardias; by mapping sequence of activation; and by evaluating patients for various forms of therapy and judging the response to therapy. Though generally quite low, the associated morbid ity and mortality in performing EP study and RFA in pediatric patients varies considerably, depending on the patient's age and size, diagnosis, associated cardiac defects, and prepro cedure condition.