Cardiac Electrophysiologist Questions Cardiac Catheterization

Are there alternatives to a catheter ablation for atrioventricular reciprocating tachycardia

My child, 9 years old has been diagnosed for with Atrioventricular reciprocating tachycardia( AVRT) since he was a baby. Over time, things have gotten worse and his doctor is now talking about doing a catheter ablation. I am petrified and want to know if there are other alternative treatments that may work? He has never been on beta blockers. Could something like digoxen work for him? What other less invasive things can we try?

16 Answers

Catheter ablation for AVRT, if done by a qualified pediatric electrophysiologist has a better than 90% success rate and less than 3% complication rate, with most complications being minor. The catheters are inserted in the groin area and there will be virtually no scars. Most procedures are completed with little or no X-rays.
I totally understand why you are petrified. However AVRT particularly in the presence of anomalous bypass tract can result in several tachycardias which can make it very difficult for the child to play study or runaround with children do. I certainly would not advise adding destruction to a nine-year-old, beta-blocker could be contraindicated if she has a bypass tract. Catheter ablation in an experienced hands is very safe and very effective when it's done in an experienced center
Digoxin is probably not an ideal first choice. Beta blockers may help or even anti-arrhythmic drugs (but these may have side effects). We do recommend doing an EP study and performing an ablation since it is curative. Complications are rare but they can be serious. Choosing an experience EP lab is a crucial first step. A pediatric electrophysiologist should perform the procedure.
There are several medications that can be tried however catheter ablation likely offers the best chance at cure at the lowest risk in the hands of an expert pediatric electrophysiologist
Ablation is the "gold standard" of therapy. It is very safe, and it is curative. The risk of a bad outcome is generally less than 1%. The alternative is life-long medication to control the rhythm. Medication does not cure it, as it is only suppressive (if it works).
A scary situation for any parent. Ablation has been around for decades. In a nine year old, it is certainly better to cure the issue than be on pills forever. Side effects of the meds are significant, especially over the next two decades. There are risks, but they are rare. Get to a nearby center that does a lot of them.
I would respectfully refer you to your electrophysiologist for the best solutions and alternatives for treatment.

Ablation is recommended if PSVT is getting worse. Digitalis potentially may increase conduction, not my advice..
There are multiple medications that could help, but they are typically not able to control the rhythm disturbance completely. Ultimately, an ablation is the best long-term option. However, the condition could probably be managed with medications until your child is older and you are more comfortable with the idea of the procedure.
Avnrt or av nodal reentry tachycardia has good cure with ablation and the risk and benefits needs to be discussed with your cardiologist. Its usually a safe procesure in experience hands.
The best treatment would be ablation as they are highly successful. The problem here is that at 9 years old he is at risk for a cardiomyopathy from rapid heart rates. Also taking medication at that age is not wise and loaded with side effects, and for how long? Digoxin does not work in active patients and also has side effects , truly ablation is the true way to treat this in a good center for pediatric care.
Medications are not as useful as ablation for AVNRT. Ablation would be the only way to terminate tachycardia. It is not a dangerous procedure and most electrophysiologists are able to terminate this rhythm the first time they do the procedure as compared to other tachycardia. Depending of how close the pathway is to the AV node, there is a risk of complete heart block and need for permanent pacemaker, but this rarely happens. I suggest you proceed with ablation.
The best treatment for AVRT is a catheter ablation procedure. if your child has Wolf Parkinson White Syndrome you will also want to know how fast the abnormal connection can conduct and if it is a fast conducting one it will be best to blame it. That being said, for patients who don't want to have an ablation procedure, beta blockers, digoxin or anti-arrhythmics like flecainide are an option.
This disorder refers to a physical bypass tract that bridges the atria to the ventricle. The electrical circuit is usually well defined and permanently responsive to catheter ablation by an EP doctor. Some medications slow the current in the AV node and actually encourage conduction over the bypass tract, resulting in tachycardia. The ablation has a high success rate, so I would strongly consider the procedure. This is general advice and may not apply to all cases.
There are several other medications that one might try. If the reentry pathway involves the AV node, a beta blocker might work. An EP study followed by ablation is a reasonable and safe option, if medications do not help.
I would highly recommend an ablation for a child who is already having symptoms at this age. Medications are usually given to very mild symptoms in adults. Children might have a lot of side effects and since this is a congenital problem, it will not go a way with time so commenting a child to life-long medications is not a good idea.