EXPERIMENTAL AND THERAPEUTIC MEDICINE 14: 3563-3568, 2017

The efficacy of radiofrequency ablation in

the treatment of pediatric arrhythmia and
its effects on serum IL-6 and hs-CRP
CHUNLI LI, LIBO JIA, ZHENZHOU WANG, LING NIU and XINJIANG AN

Department of Cardiology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221000, P.R. China

Received May 15, 2017; Accepted August 7, 2017

DOI: 10.3892/etm.2017.4960

Abstract. The aim of this study was to investigate the Introduction

efficacy of radiofrequency ablation in the treatment of
pediatric arrhythmia and to assess the changes in serum inter- Pediatric arrhythmia is a common cardiovascular disease
leukin-6 (IL-6) and hs-CRP levels after treatment. Hundred with diverse types and various symptoms observed in pedi-
and six children with tachyarrhythmia who were admitted to atric medicine. Common types of pediatric arrhythmias
Xuzhou Children's Hospital from November, 2014 to December, include atrioventricular reentrant tachycardia (AVRT),
2015 were recruited for study. The efficacies of radiofre- atrioventricular nodal reentrant tachycardia (AVNRT),
quency in the treatment of different types of arrhythmia were ventricular tachycardia (VT), idiopathic VT, cardiac conduc-
analyzed. Successful ablation was found in 104 cases (98.11%) tion disease and congenital atrioventricular block (1). Among
and recurrence was found in 7 cases (6.73%). Among 62 cases these types of arrhythmias, many cases show no obvious
of atrioventricular reentrant tachycardia (AVRT), successful symptoms and have no significant effects on children's life
ablation was found in 60 cases (96.77%) and recurrence was and health. However, some cases of arrhythmia can lead to
found in 3 cases (4.84%). Among 33 cases of atrioventricular serious clinical symptoms, with a ventricular rate surpassing
nodal reentrant tachycardia (AVNRT), successful ablation was 200 beats/min in some patients. Without intervention, the
found in 33 cases (100%) and recurrence was found in 2 cases recurrence of arrhythmia can cause persistent myocardial
(6.06%). Among 5 cases of ventricular tachycardia (VT), damage, leading to heart expansion or even sudden death (2).
successful ablation was found in 5 cases (100%) and no recur- In the past, the focus of treatment of pediatric arrhythmia
rence was found. Among 4 cases of atrial tachycardia (AT), has been the selection of proper antiarrhythmic drugs based
successful ablation was found in 4 cases (100%) and recur- on the arrhythmia types. However, this traditional treat-
rence was found in 1 case (25%). Among 2 cases of atrial ment method can only alleviate the symptoms, but cannot
flutter (AFL), successful ablation was found in both (100%) achieve radical treatment. In addition, the long-term use of
and recurrence was found in 1 case (50%). After operation, anti-arrhythmic drugs can seriously affect the growth and
the levels of IL-6 and hs-CRP were increased and were development of the patient, which limits their clinical appli-
continually increased within 6 h after operation. The levels cation (3). Nowadays, with the continuous development of
of IL-6 and hs-CRP at 24 h after operation were reduced but interventional medicine, radiofrequency ablation has become
still higher than preoperative levels. The duration of radiofre- an alternative to drug therapy in the treatment of a variety of
quency and ablation energy were positively correlated with the types of pediatric arrhythmias (4). Radiofrequency ablation
levels of IL-6 and hs-CRP, while the number of discharges was has even become the preferred method of treatment of many
not significantly correlated with either. In conclusion, radiofre- types of arrhythmias.
quency ablation is a safe and effective treatment for pediatric Radiofrequency ablation is the use of radio frequency to
arrhythmia. Postoperative monitoring of IL-6 and hs-CRP generate and direct thermal energy to destroy the key parts
levels is conducive to understanding postoperative myocardial or pathways of the heart that can cause arrhythmia (5), thus
injury and inflammatory response. eliminating the occurrence of arrhythmia. As such, radiofre-
quency ablation will inevitably have adverse effects on the
myocardium, and even cause myocardial damage (6). Studies
have pointed out that myocardial injury and myocardial
pathology changes caused by radiofrequency ablation are
Correspondence to: Dr Xinjiang An, Department of Cardiology,
correlated with an inflammatory response (7). In this study,
Xuzhou Children's Hospital, 18 Sudi North Road, Xuzhou,
Jiangsu 221000, P.R. China
radiofrequency ablation was used to treat pediatric arrhythmia
E-mail: anxinjian001@163.com and the efficacies of those methods were discussed. The
changes of serum levels of interleukin-6 (IL-6) and hs-CRP
Key words: radiofrequency ablation, pediatric arrhythmia and other inflammatory indicators were also observed before
and after operation, to explore the clinical values of the two
indicators in postoperative myocardial injury.
3564 LI et al: RADIOFREQUENCY ABLATION FOR PEDIATRIC ARRHYTHMIA AND INFLAMMATORY INDICATORS

Materials and methods Ablation of AVRT. Left accessory pathway ablation for
AVRT was performed with a small curved electrode catheter.
General information. A total of 106 children with tachyar- The ablation site is normally on the side of the ventricles, but
rhythmia admitted to Xuzhou Children's Hospital from can be the side of atrium for older patients. Ablation energy
November, 2014 to December, 2015 were enrolled, including temperature was controlled between 50-55˚C, with the power
62 males and 44 females. The ages ranged from 3 years and generally between 30-35 W. The ablation energy was adjusted
10 months to 13 years, with an average age of 8.28±4.85 years. according to the outcomes.
The patients diagnosed by the physical examination in our Right accessory pathway ablation for AVRT was performed
hospital were divided into the following categories: 62 cases with a stiffened electrode catheter. A multi-functional sheath
of AVRT (including 41 cases of left accessory pathway and was used to improve the stability of the catheter and the abla-
21 cases of right accessory pathway), 33 cases of AVNRT, tion site was generally in the right atrioventricular groove. The
5 cases of VT, 4 cases of atrial tachycardia (AT) and 2 cases ablation energy temperature was controlled between 50-55˚C,
of atrial flutter (AFL). The normal heart rate and heart rate with the power generally between 40-50 W.
during arrhythmia were recorded. Heart echocardiography Ablation of AVNRT. Radiofrequency ablation with blocked
was administered to understand the heart structure and reentry loop was primarily used to maintain the conduction
cardiac function of the patients. At least 5 half-lives of the function of the atrioventricular node in AVNRT. The 7-plus
antiarrhythmic drugs were reached or no history of the use stiffened electrode catheter was used with a multi-functional
of antiarrhythmic drugs was required of the patients before sheath to improve the stability of the catheter. The ablation
radiofrequency ablation was performed. Patients with comor- energy temperature was controlled at 50˚C, with the power
bidities of congenital heart disease, diabetes, central nervous generally between 25-30 W.
system disease or liver and kidney disease and patients with VT ablation. Idiopathic ventricular tachycardia (IVT)
a history of acute or chronic infections were excluded from is the most common type of VT in children. The areas of
the study. This study was approved by the Ethics Committee excitability are most commonly found in the right ventricular
of Xuzhou Children's Hospital. Signed written informed outflow tract (RVOT) and the left ventricular septum (ILVT),
consents were obtained from their guardians. and less commonly in other inflammatory sites such as the
left ventricular outflow tract. For children with suspected
Preparation before surgery RVOT, a 6F electrode catheter was generally used. The 6F
Preoperative examination. Before surgery, a systematic electrode catheter was pushed through the sheath into the right
physical examination was carried out along with all neces- ventricle or outflow tract. The ablation energy temperature
sary laboratory tests, including routine blood, routine urine, was controlled at 50˚C, with the power generally between
routine fecal, liver function, renal function, cardiac function, 30-40 W. For children with suspected ILVT, a 7F electrode
coagulation function, syphilis detection, hepatitis B detection catheter was generally used. The ablation energy temperature
and others. Routine 12-lead electrocardiogram, 24 h dynamic was controlled at 50˚C, with the power generally between
electrocardiogram, tomography and posterior chest exam were 30-40 W.
also performed. AT ablation. Excitatory sequence mapping was primarily
Preparation before surgery. The patients were fasted for used for AT ablation. The ablation catheter was perfused with
8 h before surgery. In addition, 4 h water deprivation was also saline. The ablation energy temperature was controlled at
performed before surgery. A collar and lead skirt were used to 40˚C, with the power generally between 30-40 W.
protect the thyroid and gonads. AFL ablation. Blocked reentry loop is the key in the
Non-tracheal intubation intravenous anesthesia using success of atrial flutter radiofrequency ablation. In the
propofol was performed for the patients younger than 12 years, present study, line-like ablation performed at the lower part
while local anesthesia using lidocaine was performed for the of the atrium was the most commonly used method and the
patients older than 12 years. 7F electrode was the most commonly used catheter. The
After anesthesia, coronary sinus mapping electrodes ablation energy temperature was controlled at 40-45˚C, with
were inserted through left subclavian vein puncture. Right the power at ~30 W.
ventricle, right atrium and His bundle mapping electrodes
were placed by right femoral vein puncture. After that, the Postoperative treatment. The patients received ECG moni-
electrophysiological maps of the body surface and the heart toring generally for 72 h immediately after surgery. Patients
were simultaneously recorded. without major complications were transferred to a general
Since a child's heart is relatively smaller than an adult's ward. Any postoperative complications, including postop-
heart, a proportionately-sized ablation catheter was selected erative arrhythmia, pericardial tamponade, wound hematoma
before surgery. The ablation catheter was positioned in the and pneumothorax, were monitored during the observation
proper place and measures were taken to ensure the proper period, with convalescent care provided. A routine 12-lead
ablation energy was applied. More specific operative details electrocardiogram, tomography and posterior chest exam were
were adhered to with reference to guidelines on pediatric performed again before discharge.
radiofrequency ablation by Friedman et al (8). Radiofrequency
ablation machines and multi-channel physiological recorders, Blood samples collection and examination. The venous
model LEAD-7000C, were purchased in Sichuan Jinjiang blood samples from all patients were collected and examined
Electronic Science and Technology Co., Ltd. (Chengdu, before surgery. The venous blood samples from all patients
China). were also collected and examined at 6 and 24 h after surgery.
 EXPERIMENTAL AND THERAPEUTIC MEDICINE 14: 3563-3568, 2017 3565

Table I. The efficacy of radiofrequency ablation in the treat- Table III. Levels of serum inflammation indicators before and
ment of different types of arrhythmia. after surgery.

Cases Success cases Failure Time-points IL-6 (pg/ml) hs-CRP (mg/l)

Types n (%) cases (%)
Before surgery 6.12±1.12 8.26±1.47
AVRT 62 60 (96.77) 2 (3.23) After surgery 8.38±2.21 10.54±2.13a,b
a,b

AVNRT 33 33 (100) 0 (0) 6 h after surgery 10.97±2.86a 13.76±3.31a

VT 5 5 (100) 0 (0) 24 h after surgery 8.87±2.67a,b 11.43±2.59a,b
AT 4 4 (100) 0 (0)
AFL 2 2 (100) 0 (0)
a
Compared with the level before surgery, p<0.05; bcompared with the
level at 6 h after surgery, p<0.05. IL-6, interleukin-6.
Total 106 104 (98.11) 2 (1.89)

AVRT, atrioventricular reentrant tachycardia; AVNRT, atrioven-

tricular nodal reentrant tachycardia; VT, ventricular tachycardia;
AT, atrial tachycardia; AFL, atrial flutter. performed using Pearson's correlation analysis for data with
a normal distribution and Spearman's correlation analysis
was used for data with a non-normal distribution. p<0.05 was
Table II. Recurrence rates of different types of arrhythmia. considered to be statistically significant.

Cases with Cases without Total Results

Type recurrence (%) recurrence (%) (cases)
The efficacy of radiofrequency ablation. Hundred and six
AVRT 3 (5.00) 57 (95.00) 60 children with tachyarrhythmia were selected for study.
AVNRT 2 (6.06) 31 (93.94) 33 Successful ablation was found in 104 cases (98.11%), while
VT 0 (0.00) 5 (100) 5 2 cases failed (1.89%). Recurrence was found in 7 cases, for a
recurrence rate of 6.73%.
AT 1 (25.00) 3 (75.00) 4
AFL 1 (50.00) 1 (50.00) 2
The efficacy of radiofrequency ablation in the treatment of
Total (cases) 7 (6.73) 97 (93.27) 104 different types of arrhythmia. Among the 62 cases of AVRT,
χ2 a 8.76a successful ablation was found in 60 cases (96.77%), while
P-value >0.05 2 cases failed (3.23%). Among the 33 cases of AVNRT,
successful ablation was found in 33 cases (100%). Among the
a
Chi-square value indicates that the difference in recurrence rates
5 cases of VT, successful ablation was found in 5 cases (100%).
between the different types of arrhythmia was not significant. AVRT,
atrioventricular reentrant tachycardia; AVNRT, atrioventricular nodal
Among the 4 cases of AT, successful ablation was found in
reentrant tachycardia; VT, ventricular tachycardia; AT, atrial tachy- 4 cases (100%). Among the 2 cases of AFL, successful abla-
cardia; AFL, atrial flutter. tion was found in 2 cases (100%) (Table I).

Recurrence rate of different types of arrhythmia. Among the

106 patients, recurrence was found in 7 cases, for a total recur-
A 6 ml blood sample was also collected from each patient rence rate of 6.73%. During follow-up, the average recurrence
each time-point. An enzyme-linked immunosorbent assay time was 7 months. Among the 62 cases of AVRT, recurrence
(ELISA) kit (Beijing Biolab Science and Technology Co. was found in 3 cases. Among the 33 cases of AVNRT, recur-
Ltd., Beijing, China) was used to detect the level of IL-6. rence was found in 2 cases (6.06%). Among the 5 cases of VT,
The detection of hs-CRP was performed using a Hitachi no recurrence was found (0.00%). Among the 4 cases of AT,
7600 automatic biochemical analyzer (Hitachi Co., Tokyo, recurrence was found in 1 case (25.00%). Among the 2 cases of
Japan). AFL, recurrence was found in 1 case (50.00%). There was no
significant difference in recurrence rates between the different
Follow-up. The patients were asked to return for follow-up with types of arrhythmia (p>0.05) (Table II).
a routine 12-lead electrocardiogram and tomography at 7 days,
1 month, 6 months and 1 year after surgery. Information on Levels of serum inflammation indicators before and after
the living conditions of the patients was obtained by regularly surgery. After the operation, the serum levels of IL-6 and
contacting the patient via phone. hs-CRP were increased and were continually increased within
6 h after operation. The levels of IL-6 and hs-CRP at 24 h after
Statistical methods. SPSS 19.0 statistical software (IBM, operation were reduced but still higher than the preoperative
New  York, NY, USA) was used to analyze the data. The levels (Table III and Figs. 1 and 2).
measurement data were expressed as mean ± standard devia-
tion and was analyzed using the independent samples t-test; Correlations between radiofrequency ablation parameters
count data were expressed as a percentage (%) and was and inflammatory indicators. The correlations between the
analyzed using the Chi-square test. The correlation test was duration of radiofrequency, ablation energy and the number
3566 LI et al: RADIOFREQUENCY ABLATION FOR PEDIATRIC ARRHYTHMIA AND INFLAMMATORY INDICATORS

Table IV. Correlations of the duration of radiofrequency, ablation energy and the number of discharges with the inflammatory
indicators.

Duration of radiofrequency (s) Ablation energy (J) No. of discharges (times)

----------------------------------------------------------- ---------------------------------------------------- ----------------------------------------------------
r-value P-value r-value P-value r-value P-value

IL-6 a
0.503 <0.05 a0.453 <0.05 0.191 0.008
Hs-CRP a
0.374 <0.05 a0.327 <0.05 0.065 0.44

Correlation coefficient (r) between factors was significant (p<0.05). IL-6, interleukin-6.
a

Figure 1. The changes in interleukin-6 (IL-6) levels after operation.

Enzyme‑linked immunosorbent assay (ELISA) results showed that the level Figure 2. The changes in Hs-CRP levels after operation. Biochemical
of IL-6 was increased and was continually increased within 6 h after opera- analysis showed that the level of Hs-CRP was increased and was continually
tion. The level of IL-6 at 24 h after the operation was still higher than the increased within 6 h after operation. The level of Hs-CRP at 24 h after opera-
preoperative levels. tion was still higher than the preoperative levels.

of discharges with the inflammatory indicators were analyzed. antiarrhythmic drugs can trigger adverse side effects among
The results showed that the duration of radiofrequency children (3). In addition, cardioversion cannot prevent the
and ablation energy were positively correlated with the recurrence of arrhythmia. Therefore, those two methods both
levels of IL-6 and hs-CRP, while the number of discharges have limitations (10).
was not significantly correlated with the levels of IL-6 or In the 1990s, the pathophysiology of tachyarrhythmia
hs-CRP (Table IV). was gradually elucidated. Heart electrophysiological exami-
nation, which can be used to determine the origins of these
Complications. Among the 106 cases, complete atrioventric- arrhythmias, provides the basis for the application of radiofre-
ular block was found in 1 case after radiofrequency ablation. quency ablation in the treatment of tachyarrhythmia. In 1989,
No serious complications or deaths were observed among the radiofrequency ablation was first used to treat children with
patients over the course of the study. Wolff-Parkinson-White syndrome; in 1991, radiofrequency
ablation was then used in the treatment of pediatric tachyar-
Discussion rhythmia (11). With the development of radiofrequency
ablation and the continuous improvements of its techniques,
Tachyarrhythmia is a common disease with different radiofrequency ablation has become widely used in the treat-
symptoms observed in pediatric cardiovascular medicine. ment of pediatric tachyarrhythmia. Due to the advantages
Tachyarrhythmia shows no obvious symptoms in some patients of better safety, reliable treatment effect and reduced risk
and can only be detected by physical examination. While of trauma (12), this method has now been accepted by most
some patients showed paroxysmal palpitations, chest tightness medical institutions in the world (13,14). Radiofrequency
and even syncope has been known to occur in severe cases. ablation has replaced antiarrhythmic drugs, cardioversion
Without proper treatment, the recurrence of tachyarrhythmia and surgery to become the main therapy in the treatment of
can cause changes in the body's hemodynamics and possible pediatric tachyarrhythmia (15).
secondary expansion and reduced cardiac function, and may In this study, successful ablation was observed in 104 out
finally lead to the development of cardiomyopathy (9). These of 106 cases of tachyarrhythmia, accounting for 98.11% of all
diseases can not only seriously affect the physical and mental cases, while recurrence was found in 7 cases, accounting for
health of children, but also bring heavy economic burden to the 6.73%, indicating an overall satisfactory treatment efficacy.
patient's family. In the past, anti-arrhythmic drugs and cardio- Specifically, 62 cases of AVRT (58.49%), 33 cases of AVNRT
version were widely used in the treatment of arrhythmia, but (31.13%), 5 cases of VT (4.72%), 4 cases of AT (3.77%) and
 EXPERIMENTAL AND THERAPEUTIC MEDICINE 14: 3563-3568, 2017 3567

2 cases of AFL (1.89%) constituted the 106 cases. Most of increase the thermal effect on the myocardium and cause a higher
the patients (95 cases) had AVRT or AVNRT, accounting for degree of myocardial damage (23). In addition, greater ablation
89.62% of cases, which is consistent with previous studies that energy results in proportionately increased organization of the
showed supraventricular tachycardia to be the most common interface temperature and current density, thereby impacting the
type of pediatric tachyarrhythmia, accounting for ~90% of heart with more severe thermal injury of the myocardium (24).
all cases of pediatric arrhythmias (16). Among the 62 cases Therefore, tactical control of the radiofrequency duration and
of AVRT patients, 60 cases showed successful ablation and the rational use of radiofrequency energy levels may help reduce
2 cases failed, for a success rate of 96.77%, indicating a satis- myocardial injury and inflammatory response.
factory treatment efficacy. In conclusion, radiofrequency ablation is a safe and effec-
The 3 cases of recurrence, which were all found in the tive therapy in the treatment of pediatric arrhythmia. The
left-sided accessory pathways, were due to the lack of a postoperative monitoring of the changes of IL-6 and hs-CRP
coronary sinus electrode to serve as the reference electrode can be used to understand the damage of the postoperative
and the difference in anatomical structure between the two myocardial tissue and the inflammatory reaction, which
sides, which resulted in incomplete ablation. In this study, provides the basis for the application and control of reasonable
the ablations in patients with AVNRT were all successful radiofrequency energy and duration during surgery.
and the success rate was higher than previously reported
(95.7‑97%) (4), which may be due to the relatively small sample References
size of the present study. The ablations in patients with VT
were all successful and the success rate was higher than previ-  1. Blaufox AD, Paul T and Saul JP: Radiofrequency catheter
ously reported (17). Likewise, a possible explanation is the ablation in small children: Relationship of complications to
small sample size of our study. None of the patients with AT application dose. Pacing Clin Electrophysiol 27: 224-229, 2004.
of AFL had a failure of the treatment, but their recurrence rate  2. Blaufox AD, Felix GL and Saul JP; Pediatric Catheter Ablation
Registry: Radiofrequency catheter ablation in infants ≤18 months
was comparatively high. Further studies with larger number of old: when is it done and how do they fare?: Short-term data from
samples would help to increase the frequencies of diagnoses the pediatric ablation registry. Circulation 104: 2803-2808, 2001.
of tachyarrhythmia types and improve the evaluation of the  3. Wazni O, Martin DO, Marrouche NF, Shaaraoui M, Chung MK,
Almahameed S, Schweikert RA, Saliba WI and Natale A: C
efficacies of their treatment. reactive protein concentration and recurrence of atrial fibrillation
At present, the most commonly reported complications of after electrical cardioversion. Heart 91: 1303-1305, 2005.
radiofrequency ablation include atrioventricular block, acute  4. Sakaguchi H, Miyazaki A, Yamamoto M, Kurosaki K, Ohuchi H,
Satomi K, Suyama K and Yamada O: Clinical characteristics
pericardial tamponade, peripheral vascular injury and bleeding, of focal atrial tachycardias arising from the atrial appendages
pneumothorax and thromboembolism (18). In this study, 1 out during childhood. Pacing Clin Electrophysiol 34: 177-184, 2011.
of 106 patients showed a slight degree of atrioventricular block.  5. Morady F: Radio-frequency ablation as treatment for cardiac
arrhythmias. N Engl J Med 340: 534-544, 1999.
This occurrence had no adverse effects on the child's life and  6. Alaiti MA, Maroo A and Edel TB: Troponin levels after cardiac
health and regular follow-up care was performed as for all electrophysiology procedures: Review of the literature. Pacing
cases. Overall, the results indicate that radiofrequency ablation Clin Electrophysiol 32: 800-810, 2009.
 7. Conway DS, Buggins P, Hughes E and Lip GY: Prognostic signif-
is safe but attention to the occurrence of the aforementioned icance of raised plasma levels of interleukin-6 and C-reactive
complications and timely treatment are necessary. protein in atrial fibrillation. Am Heart J 148: 462-466, 2004.
After radiofrequency ablation, the pathological changes of  8. Friedman RA, Walsh EP, Silka MJ, Calkins H, Stevenson WG,
Rhodes LA, Deal BJ, Wolff GS, Demaso DR, Hanisch D, et al;
the ablation site are mainly coagulation necrosis, which is due NASPE Expert Consensus Conference: Radiofrequency catheter
to the thermal effects caused by radio frequency energy (19). ablation in children with and without congenital heart disease.
After treatment, acute inflammatory responses, such as the Report of the writing committee. North American Society of
Pacing and Electrophysiology. Pacing Clin Electrophysiol 25:
rapid exudation of monocytes and neutrophils, can be observed 1000-1017, 2002.
around the necrotic tissue, indicating significant myocardial  9. Allessie M, Ausma J and Schotten U: Electrical, contractile
injury in the affected necrotic area (20). In human body, Hs-CRP and structural remodeling during atrial fibrillation. Cardiovasc
Res 54: 230-246, 2002.
is an acute-phase reaction protein with high sensitivity, and the 10. Tieleman RG, De Langen C, Van Gelder IC, de Kam  PJ,
increase of Hs-CRP usually indicates an inflammatory reac- Grandjean J, Bel KJ, Wijffels MC, Allessie MA and Crijns HJ:
tion in the body (21). IL-6 is an interleukin that functions as a Verapamil reduces tachycardia-induced electrical remodeling of
the atria. Circulation 95: 1945-1953, 1997.
cytokine protein and can be secreted by macrophages or other 11. Walsh EP and Saul JP: Transcatheter ablation for pediatric
cells after injury. IL-6 is an important inflammatory factor in tachyarrhythmias using radiofrequency electrical energy. Pediatr
the human body. IL-6 can not only induce an acute inflamma- Ann 20: 386-392, 388-392, 1991.
12. Van Hare GF, Javitz H, Carmelli D, Saul JP, Tanel RE,
tory response, but can also activate a variety of immune cells Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, et al;
to promote their differentiation and activation, which in turn Pediatric Electrophysiology Society: Prospective assessment
increases the cell damage caused by inflammation (22). after pediatric cardiac ablation: Demographics, medical profiles,
and initial outcomes. J Cardiovasc Electrophysiol 15: 759-770,
In this study, IL-6 and hs-CRP levels were increased imme- 2004.
diately after radiofrequency ablation. The levels reached a peak 13. Borger van der Burg AE, de Groot NM, van Erven L, Bootsma M,
at 6 h after operation, and were still higher than normal levels at van der Wall EE and Schalij MJ: Long-term follow-up after
radiofrequency catheter ablation of ventricular tachycardia: A
24 h after operation. This suggests that inflammation occurred successful approach? J Cardiovasc Electrophysiol 13: 417-423,
in the early stages after radiofrequency ablation. IL-6 and 2002.
hs-CRP levels after the operation were positively correlated with 14. Raungratanaamporn O, Bhuripanyo K, Sriratanasathavorn  C
and Chotinaiwattarakul C: Radiofrequency catheter ablation
the duration of radiofrequency and the time of ablation. This for various tachyarrhythmias: Experience in the Bangkok Heart
suggests that extended durations of radiofrequency ablation can Institute. J Med Assoc Thai 86 (Suppl 1): S105-S109, 2003.
3568 LI et al: RADIOFREQUENCY ABLATION FOR PEDIATRIC ARRHYTHMIA AND INFLAMMATORY INDICATORS

15. Lee PC, Hwang B, Chen SA, Tai CG, Chen YJ, Chiang  CE 21. Rifai N and Ridker PM: High-sensitivity C-reactive protein:
and Meng CC: The results of radiofrequency catheter ablation A novel and promising marker of coronary heart disease. Clin
of supraventricular tachycardia in children. Pacing Clin Chem 47: 403-411, 2001.
Electrophysiol 30: 655-661, 2007. 22. Cruickshank AM, Oldroyd KG and Cobbe SM: Serum inter-
16. Joung B, Lee M, Sung JH, Kim JY, Ahn S and Kim S: Pediatric leukin-6 in suspected myocardial infarction. Lancet 343:
radiofrequency catheter ablation: Sedation methods and success, 974-981, 1994.
complication and recurrence rates. Circ J 70: 278-284, 2006. 23. Hirose H, Kato K, Suzuki O, Yoshida T, Oguri M, Yajima K,
17. Baksiene D, Sileikiene R, Sileikis V, Kazakevicius T, Zabiela V, Hibino T and Yokoi K: Diagnostic accuracy of cardiac markers
Zebiene M and Puodziukynas A: Idiopathic ventricular tachy- for myocardial damage after radiofrequency catheter ablation.
cardia in children: Curative therapy with radiofrequency ablation. J Interv Card Electrophysiol 16: 169-174, 2006.
Medicina (Kaunas) 43: 803-807, 2007. 24. Emkanjoo Z, Mottadayen M, Givtaj N, Alasti M, Arya A,
18. Lee SJ and Schueller WC: Tachycardias in infants, children and Haghjoo  M, Fazelifar AF, Alizadeh A and Sadr-Ameli  MA:
adolescents: Safety and effectiveness of radiofrequency catheter Evaluation of post-radiofrequency myocardial injury by
ablation. Cardiology 94: 44-51, 2000. measuring cardiac troponin I levels. Int J Cardiol 117: 173-177,
19. Wren C: Catheter ablation in paediatric arrhythmias. Arch Dis 2007.
Child 81: 102-104, 1999.
20. Dudar TE and Jain RK: Differential response of normal and
tumor microcirculation to hyperthermia. Cancer Res 44:
605-612, 1984.