The role of isoproterenol testing following radiofrequency catheter ablation of accessory pathways in children.
Academic Article
Overview
abstract
Isoproterenol (ISO) testing following radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in children is often performed to assess efficacy. However, its role in postablative testing for this indication has not been previously studied. In view of a recent national shortage of ISO, this study reviewed the results of ISO testing in pediatric patients after acutely successful RFCA to evaluate its role in postablative testing. Seventy patients (median age 13.0 years, range 2.8-24 years) underwent acutely successful RFCA for APs. If AP conduction was not present and tachycardia was not inducible with programmed stimulation 30 minutes following RFCA, repeat testing was performed during continuous infusion ISO. ISO infusion resulted in the induction of arrhythmias in 3 (4%) of 70 patients that required further ablative therapy. None of these patients had inducible arrhythmias or AP conduction during postablative testing without ISO infusion. One patient, with the permanent form of junctional reciprocating tachycardia (PJRT), had persistence of AP conduction requiring further RFCA applications. Two patients had inducible AV nodal reentrant tachycardia (AVNRT) that was treated with slow pathway modification. At a median follow-up of 7.3 months, two (3%) patients had recurrence of tachycardia. These patients did not have inducible tachycardia, AP conduction, or dual AVN physiology with ISO testing. Although ISO may improve AP conduction in patients with PJRT and uncover AVNRT, these results suggest that ISO testing after an apparently successful AP ablation may not be necessary to confirm acute success. In addition, lack of AP conduction on ISO did not rule out the possibility of medium-term recurrence.
