Surgical treatment of cardiac dysrhythmias in infants and children.
A variety of cardiac rhythm disturbances that occur in infants and children may be refractory to medical or catheter ablation therapy, or both, and thus require surgical ablation. These dysrhythmias include Wolff-Parkinson-White syndrome, atrial automatic tachycardia, atrioventricular node reentry tachycardia, and ventricular tachycardia. The surgical technique originally used in adults may be equally well applied in infants and small children. In the interval from July 1, 1984, through December 31, 1993, a total of 130 infants and children (< or = 16 years old) underwent surgical treatment for various forms of dysrhythmias (96 with Wolff-Parkinson-White syndrome, 8 with atrioventricular node reentry, 11 with atrial automatic tachycardia, and 15 with ventricular tachycardia). The success rate for completely abolishing these arrhythmias has been 92% for the Wolff-Parkinson-White syndrome, 100% for atrioventricular node reentry, and 64% for atrial automatic tachycardia. In infants younger than 2 years, the success rate for the surgical treatment of ventricular tachycardia is 100%, but the long-term success in older children has been poor. One patient sustained a severe intraoperative neurologic event that resulted in her death (operative mortality, 0.7%). Ventricular function returned to normal in all patients in whom it was abnormal preoperatively. These data suggest that the surgical treatment of these dysrhythmias remains a viable alternative in those patients whose dysrhythmias are refractory to medical therapy, those in whom catheter ablation has been unsuccessful, or those in whom both situations apply.