Radiofrequency ablation of supraventricular tachyarrhythmias in newborns and infants: why, when, and how?

Supraventricular tachyarrhythmias (SVTs) in newborns and infants (< 1 year) can usually be managed with antiarrhythmic drug therapy and often resolve spontaneously within the first year of life. However, some SVTs may be drug-refractory, leading to hemodynamic instability or tachycardia-induced cardiomyopathy, necessitating catheter ablation. Refinements in ablation techniques like electro-anatomical mapping and increased expertise have made catheter ablation an effective option for young children (< 5 years). Nonetheless, due to a lack of large-scale studies involving newborns and infants (< 1 year), concerns persist regarding the risk of major complications associated with ablation energy in small hearts. Potential risks include coronary artery lesions, valve damage, vessel injury, complications related to the transseptal puncture, and ablation lesion growth. In this review, we discuss the current literature on the indications, techniques, and outcomes of radiofrequency catheter ablation in newborns and infants, illustrated by recent cases.