Pediatric Heart Expert Forum
Honest opinion
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Questions in this forum are answered by pediatric cardiologists, cardiothoracic surgeons and anesthesiologists from The Children's Hospital of Philadelphia. This forum is for questions and support about pediatric heart problems, symptoms and topics such as heart murmurs, palpitations, fainting, chest pain, congenital heart defects (including management and intervention), fetal cardiology, adult congenital cardiology, arrhythmias and pre-participation athletic screening.

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Honest opinion

My son had open heart surgery to repair ASD and PAPVR and develop SVT (AVNRT) shortly after surgery. He has been on 6.5mg amiodarone and 6ml of digoxin. These   meds was working and he had a small amount of SVT, but we decided the medication had too many side effects so they change him to 6ml flecainide  3x daily the doctors has told me that the flecainide is not working very well, and he is having too much SVT and recommended an cath ablation. I wrote a similar question, but I really didn’t understand what the percentage risk rate is for a 4yr. old 37 lbs.  Can you please tell me that? Also, can you give me your very honest opinion? If this was your child, would you try another medication and keep monitoring him for about another year to give him more time to grow.  I understand that you cannot tell me what to do, and it is my decision but I just want to make sure I understand what the risk rate is and also what are some complications this age group might have. Can you tell me if your hospital does cath ablation on this age group and what is your outcome for this procedure?  Say you have this done in one of the US top 3 hospitals, will the percentage be the same for risk? Is there another medication you might recommend?
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Dear JW,

As previously posted, the reported risk for complications in patients less than 5 years of age in an older study was 18% (as compared to 3% when older).  My recommendation here is that you obtain a second opinion.  That way, you can speak directly with the electrophysiologist and discuss medication vs. ablation options.  Without evaluating your son, his ECG, his anatomy, etc., I cannot tell you what the right course of therapy is.  And, it would be unfair to you (and him) if I were to guess at a therapy with only some of the information.  For something as invasive as an electrophysiology study with radiofrequency ablation for persistent SVT in a child less than five years of age, I would definitely seek another evaluation at an instiuttion that performs a large number of electrophysiology studies and ablations.
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Marie M Gleason, M.D.Blank
The Children’s Hospital of Philadelphia
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Jeffrey R Boris, M.D.Blank
The Children’s Hospital of Philadelphia
Philadelphia, PA
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