Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + • Treatment of supraventricular tachycardia (SVT).• Life-threatening arrhythmia unresponsive to medications.• Younger children with arrhythmia refractory to antiarrhythmic medications.• Older children with recurrent SVT.• Older children with SVT associated with preexcitation.• Treatment of ventricular tachycardia.• Younger children with life-threatening ventricular tachycardia refractory to medications.• Older children with recurrent ventricular tachycardia refractory to medications.• Older children with recurrent ventricular tachycardia who are unable to tolerate medications due to side effects, or who choose to have procedure. +++ Absolute + • Lack of vascular access. +++ Relative + • Infants with arrhythmia controlled by medications.• Patients with multiorgan system disease.• Patients with hemodynamic instability unable to tolerate procedure or anesthesia. + • Cardiac catheterization laboratory.• Biplane fluoroscopy.• Monitoring for continuous heart rate, blood pressure, oxygen saturation.• Respiratory monitoring and support.• Vascular access.• Anesthesia.• Resuscitation equipment, including medications and cardiac defibrillator.• Electrode catheters, ablation catheters, energy delivery generator. ++Table Graphic Jump Location | Download (.pdf) | Print• Risks are higher for small children (< 12–15 kg); lesion growth occurs in the immature heart.+ • Hemodynamically unstable arrhythmias.• Bleeding.• Infection.• Vascular injury, including coronary artery damage.• Pneumothorax.• Cardiac perforation.• Thromboembolism.• Stroke.• 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 ablation.• 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 than above.• Ablation of ventricular tachycardias: Lower success rate than SVT.• 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 10–13 years.• Delaying intervention until child is older and larger may be indicated. + • 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 venous access. + • 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 and head.• Shielding of gonads ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth