Frequencies, Costs, and Complications of Catheter Ablation for Tachyarrhythmias in Children: 2000–2009 VIBHA C.A. DESAI, M.S.,* CHRISTINA M.L. KELTON, PH.D.,† , * RICHARD J. CZOSEK, M.D.,‡ and PAMELA C. HEATON, PH.D.* From the *James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio; †Carl H. Lindner College of Business and College of Pharmacy, University of Cincinnati, Cincinnati, Ohio; and ‡Department of Pediatric Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Background: Over the past two decades, catheter ablation (CA) has revolutionized the treatment of tachyarrhythmias in children by providing a relatively safe and effective alternative to open heart surgery or lifelong pharmacotherapy. This study (1) described national trends in pediatric CAs and their associated costs and complications and (2) predicted the likelihood of major complications based on patient and hospital characteristics. Methods: Inpatient data were obtained from the Kids’ Inpatient Database for the years 2000, 2003, 2006, and 2009. Outpatient data were obtained from the California, Maryland, and New Jersey State Ambulatory Surgery Databases for the years 2006 and 2009. Logistic regression was used to predict the odds of major complications from CA. Results: There was a 20% increase (4,134–4,967) in the number of pediatric CAs performed from 2006 to 2009 that was concomitant with a decrease in the percentage of those procedures being performed as inpatient procedures (2,254–1,846). In 2009, a complication rate of 4.81% was estimated. For inpatient CAs, higher risk patients (with congenital heart disease, congestive heart failure, or heart transplant), ablations for ventricular tachycardias, and low-CA-volume hospitals were associated with increased risk of complications. In 2009, the mean cost of a hospitalization involving CA, but no cardiac surgery, was $17,204 (standard error = $1,015). Conclusions: CA has increasingly been used over the past decade for pediatric patients with a multitude of tachycardia mechanisms. There continues to be a small risk of major complications, especially for higher risk children and in hospitals with more limited experience with the procedure. (PACE 2013; 00:1–13) catheter ablation, Kids’ Inpatient Database, ventricular tachycardia, supraventricular tachycardia, atrioventricular block, burden of illness Introduction Tachycardia is one of the most common cardiac disorders. The incidence rate of supraven- tricular tachycardia (SVT), the most common type of tachycardia in children, has been reported to be 20–30 per 100,000 children per year. 1,2 Quality of life is substantially affected in symptomatic patients with tachyarrhythmia due to frequent clinical episodes and visits to the emergency room. Moreover, some tachyarrhythmias, such as those associated with Wolff-Parkinson-White syndrome Financial support: None. Conflict of Interest: The authors report no conflicts of interest. Address for reprints: Christina M.L. Kelton, PH.D., University of Cincinnati, Carl H. Lindner College of Business, 2925 Campus Green Drive, Cincinnati, OH 45221–0195. Fax: 513- 556-0979; e-mail: chris.kelton@uc.edu Received December 21, 2012; revised March 16, 2013; accepted April 18, 2013. doi: 10.1111/pace.12191 as well as some forms of ventricular tachycardia (VT), can be life threatening. 3,4 The advent of radiofrequency catheter abla- tion (CA) in 1989 revolutionized the treatment of tachyarrhythmias in children. 5 Potentially a curative procedure that avoids long-term phar- macotherapy, CA has become a first-line therapy for many children with symptomatic tachycardia and most patients refractory to medical ther- apy. Several single and multicenter trials have provided evidence that radiofrequency CA is a generally safe and effective mode of therapy in children. 6–8 Moreover, technological advances over the past decade, such as electroanatomic mapping systems, cryoablation, and irrigated- tip catheters, have served to make ablation of complex-arrhythmia patients increasingly safe and effective. 9–12 Nevertheless, despite its high success rate, CA continues to have a small risk of major complications such as atrioventricular (AV) nodal damage, bleeding, cardiac perforation, and even cardiac arrest. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc. PACE, Vol. 00 2013 1