Recent Developments in Pediatric and Congenital Electrophysiology

Abstract

Pediatric electrophysiology is a relatively young subspecialty of Pediatric Cardiology, but it has experienced rapid progress in the last 2 decades. The revolutionary therapy of tachyarrhythmias with catheter ablation transformed the field of pediatric electrophysiology in a similar or even more dramatic way to that of adult electrophysiology. Improvements in technology have made catheter ablation safe in children. Exposure to radiation can now be markedly decreased with non-fluoroscopic imaging methods. The use of cryothermal energy has made ablation safer in the vicinity of the AV node or the coronary arteries. Complex postoperative atrial arrhythmias can be managed with advanced electroanatomic mapping technologies. Postoperative ventricular tachycardia can be treated with a combination of pharmacologic therapy, catheter ablation, surgical methods and implantable defibrillator implantation. Genetically determined arrhythmias can be diagnosed and treated more effectively with molecular genetic testing, pharmacologic methods, surgical techniques such as sympathetic denervation and defibrillators. Pediatric electrophysiologists have also adapted techniques of cardiac resynchronization to children and patients with congenital heart disease. Overall, these developments make the present and feature of pediatric electrophysiology very exciting and promising.