Neonatal cardiac ablation: 25-year experience

Abstract Background Incessant neonatal supraventricular tachycardias (SVT) are associated with high morbidity and mortality rates. In cases refractory to pharmacological treatment, cardiac ablation (CA) has emerged as a viable therapeutic option. Objective To evaluate the safety, effectiveness, and complications of CA in neonates with refractory SVT, as well as long-term survival outcomes. Methods A retrospective observational study was conducted on 38 neonates (mean weight 3,250g [± 760g]; mean age at procedure 21.8 days [± 10.77d]) who underwent CA between 1998 and 2024. Acute success rates, recurrences, intra- and post-procedural complications, and long-term survival, recurrence, and ischemic signs were analyzed. Follow-up included electrocardiograms, echocardiograms, and stress tests. Results Radiofrequency ablation was used in all cases. The acute success rate reached 97.3%. Eight patients experienced SVT recurrence; of these, three required a second ablation, and five were successfully managed with pharmacological treatment. One major complication (mechanical perforation in a patient with cardiac malformation) was reported, with no cases of permanent atrioventricular block (AVB) or neurological damage. Minor complications included transient AVB in two patients and moderate to severe valvular insufficiency in four, all managed without significant consequences. The recurrence-free survival rate was 93.8% at 10 days, increasing to 97% from the seventh month onward. No ischemic abnormalities have been detected in long-term follow-up. The mean follow-up duration was 10.17 years, demonstrating the durability of the treatment. Conclusions Cardiac ablation is a safe and effective intervention for neonates with pharmacologically refractory SVT, particularly in specialized centers. The results suggest low complication rates and excellent long-term recurrence-free survival, supporting its consideration as a rescue treatment in this vulnerable population.