Meta-analysis of the efficacy and safety of radiofrequency catheter ablation for pediatric paroxysmal supraventricular tachycardia.

INTRODUCTION: This meta-analysis was to evaluate the efficacy and safety of radiofrequency catheter ablation (RFCA) in treating children with paroxysmal supraventricular tachycardia (PSVT).

METHODS: From inception to December 16, 2023, PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), VIP (Chinese Science and Technology Periodical Database), and WanFang were searched for this meta-analysis. Children under the age of 18, diagnosed with atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) were enrolled. The outcomes included the success rate of RFCA, the recurrence rate of PSVT following RFCA treatment, and any complications associated with the procedure. Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The outcome data were represented as rates (RATE), and corresponding 95% confidence intervals (CIs). Subgroup analyses were conducted based on regions and follow-ups.

RESULTS: Fourteen articles encompassing 6,032 children were included in the study. RFCA demonstrated remarkable efficacy in children patients, achieving success rates of 98% (RATE: 0.98, 95% CI: 0.96 to 0.99) for AVRT and 99% (RATE: 0.99, 95% CI: 0.98 to 1.00) for AVNRT. The analysis also reveals that post-RFCA, the recurrence rates for AVRT were 5% (RATE: 0.05, 95% CI: 0.03 to 0.07), while for AVNRT, they were slightly lower at 4% (RATE: 0.04, 95% CI: 0.02 to 0.08). In the subset of Asian children patients, these recurrence rates were observed to be 5% for AVRT and 3% for AVNRT. Monitoring for a duration of up to 12 months post-RFCA indicated recurrence rates of 4% for AVRT and 3% for AVNRT. However, for follow-up periods extending beyond one year, there was a slight increase in these rates to 4% for AVRT and 6% for AVNRT. Additionally, the complication rates associated with RFCA in the children population were relatively minimal, recorded at 2% (RATE: 0.02, 95% CI: -0.01 to 0.06) for AVRT and 1% (RATE: 0.01, 95% CI: 0.00 to 0.02) for AVNRT.

CONCLUSION: RFCA appears to be a highly effective and safe treatment option for AVRT and AVNRT in children, with high success rates and relatively low recurrence and complication rates. However, long-term follow-up may be necessary to monitor for potential recurrences. These findings are valuable for clinicians and patients in making informed decisions about the treatment of these cardiac arrhythmias in pediatric patients.