The combination of improved diagnostic techniques, new and potent
antiarrhythmia agents, and progress in antiarrhythmia
surgical procedures has resulted in successful management of complex
cardiac arrhythmia in children. The kinds of
arrhythmia that can be considered for possible surgical intervention share several features. Each produces symptoms and usually is hemodynamically compromising. Each requires extensive preoperative and intraoperative electrophysiologic evaluation to establish the mechanism, response to drugs, and suitability for surgery. Although reports of surgical
arrhythmia treatment have been limited in children, with increasing success the indications for such treatment may become less stringent. Our recommendations are shown in the Table. In general, patients intolerant of or unresponsive to medical treatment for symptomatic
arrhythmia (
tachycardia or
bradycardia), should be considered candidates for surgical antiarrhythmia procedures. These patients should be referred for testing to cardiac centers staffed by pediatric cardiac electrophysiologists and surgeons experienced in
arrhythmia diagnosis and ablation. Careful evaluation can identify those patients in whom surgical approaches are most appropriate. At present, surgical operations for selected, serious pediatric
cardiac arrhythmias offer definitive and possibly curative treatment, and may be preferable to inadequate, poorly tolerated, or long-term medical
therapy.