• Infants with arrhythmia controlled by medications.
• Patients with multiorgan system disease.
• Patients with hemodynamic instability unable to tolerate procedure
• Cardiac catheterization laboratory.
• Biplane fluoroscopy.
• Monitoring for continuous heart rate, blood pressure, oxygen
• Respiratory monitoring and support.
• Vascular access.
• Resuscitation equipment, including medications and cardiac defibrillator.
• Electrode catheters, ablation catheters, energy delivery generator.
• Hemodynamically unstable arrhythmias.
• Vascular injury, including coronary artery damage.
• Cardiac perforation.
• Radiation exposure.
• Cardiac valve injury.
• Conduction system injury, including complete heart block; may
necessitate implantation of permanent pacemaker.
• Risk of injuring the normal conduction system is highest for
right septal ablation sites.
• Cardiac arrest.
• Not all arrhythmias are amenable to catheter
• Highest success rates are for SVT due to accessory connections
or for atrioventricular nodal reentry tachycardia.
• Automatic atrial tachycardias, especially due to a single automatic
focus, are amenable to ablation, with slightly lower success rates
• Ablation of ventricular tachycardias: Lower success rate than
• Primary electrical disorders, such as long QT syndrome, are not
amenable to catheter ablation.
• Availability of noncontact mapping systems and “global positioning” systems
reduces fluoroscopy time.
• Neonatal SVT often improves substantially during first 18 months
of life and frequently recurs later, such as ages 5–8 and
• Delaying intervention until child is older and larger may be
• Patient should not have any oral intake for at
least 4 hours before the study.
• Antiarrhythmic medications are generally withdrawn for at least
5 half-lives prior to ablation.
• Sedation is administered; general anesthesia is often preferred
for lengthy procedures or for younger patients.
• Intravenous access is necessary, usually femoral venous, often
bilaterally and multiple, in addition to internal jugular or subclavian
• Supine, with protection of airway.
• Arms are positioned at sides for long procedures, to avoid potential
brachial plexus injury.
• Adequate padding to avoid pressure injury is needed for extremities
• Shielding of gonads from radiation is necessary.
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