Ectopic activity and β-adrenergic reactivity of erythrocyte membranes in children with ventricular arrhythmia after radiofrequency ablation: a pilot observational study

Background. Ventricular arrhythmias (VA) in children are characterized by a high recurrence rate after radiofrequency ablation (RFA). Given the important role of autonomic dysregulation in arrhythmogenesis, the erythrocyte membrane β-adrenergic reactivity (β-ARM), reflecting β-adrenergic receptor desensitization, can be used to personalize approaches to the management of pediatric patients.

Aim: To analyze the relationship between residual ectopic activity (EA) and VA recurrence in children before, on the third day, and in the late period after RFA with β-ARM levels.

Material and Methods. Ten patients aged 9–17 years with VA (EA >10%) were included. β-ARM levels and the presence of ventricular extrasystoles (VEPs) based on Holter ECG monitoring were determined before RFA, on the third day, and 6–18 months after RFA. One obese patient was excluded from the β-ARM analysis.

Results. Recurrent VEPs (≥10%) were recorded in 2 patients (20%), with residual activity <10% in 2 patients (20%). Visually, the baseline β-ARM was lower in patients without recurrence. Early changes in β-ARM were chaotic (influence of stress, anesthesia). In the late period, two zones were identified: ≤8.97 conventional units (absence of VEPs, n=5) and ≥13.68 conventional units (residual activity 5–19%, n=4). A statistically significant reduction in β-ARM was observed only in the group without VES (p=0.043).

Conclusion. Low preoperative β-ARM is associated with a favorable outcome, and long-term zonation and reduction in patients free of recurrence confirm the reversibility of sympathetic hyperactivation. β-ARM can be used to personalize follow-up care in children after RFA.

1. Allam L.E., Nabih M.A., Helal M.B., et al. The Impact of High Burden Idiopathic Premature Ventricular Contractions in Pediatric versus Adult Populations. A Retrospective Cohort Study. Pediatr. Cardiol. 2026;47(1):435–444. DOI: 10.1007/s00246-025-03784-x

2. Flore F., Lioncino M., Cicenia M., et al. Premature ventricular contraction-induced ventricular dysfunction in children without structural heart disease: a systematic review and meta-analysis. Europace. 2025;27(8):euaf167. DOI: 10.1093/europace/euaf167.

3. Manickavasagam A., Roshan J. Catheter ablation of pediatric ventricular arrhythmias: A work in progress. Indian Pacing Electrophysiol. J. 2023;23(4):108–109. doi: 10.1016/j.ipej.2023.06.002

4. Dalili M, Kargarfard M, Tabib A, Fathollahi MS, Brugada P. Ventricular tachycardia ablation in children. Indian Pacing Electrophysiol J. 2023;23(4):99–107. DOI: 10.1016/j.ipej.2023.03.002

5. Gulletta S., Vergara P., Vitulano G., et al. Etiology is a predictor of recurrence after catheter ablation of ventricular arrhythmias in pediatric patients. J. Cardiovasc. Electrophysiol. 2021;32(5):1337–1345. DOI: 10.1111/jce.14984

6. Sorokvasha O.V., Shkolnikova M.A., Termosesov S.A. Radiofrequency catheter ablation of ventricular arrhythmias in pediatric patients: assessment of effectiveness and risk factors of recurrence. Journal of Arrhythmology. 2014;(75):22–28. (In Russ.) EDN: TJSBGL

7. Chueva K.A., Tatarskiy R.B., Lebedev D.S., et al. Predictors of unsuccessful radiofrequency catheter ablation of idiopathic ventricular arrhythmias in children. Siberian Journal of Clinical and Experimental Medicine. 2023;38(4):133–140. (In Russ.) DOI: 10.29001/2073-8552-2023-38-4-133-140 EDN: XLTRWQ

8. Lutfi M.F., Elhakim R.F., Mohammed E.E.A. Physiological Basis and Clinical Significance of Heart Rate Variability. South Eastern European Journal of Public Health. 2024;26:3579–3591. DOI: 10.70135/seejph.vi.5771

9. Yakimova E.V., Svintsova L.I., Rebrova T.Yu., Muslimova E.F., Jaffarova O.Yu., Afanasyev S.A. Beta-adrenergic reactivity of erythrocyte membranes as a biomarker of the clinical phenotype of supraventricular reentrant tachycardias in children. Siberian Journal of Clinical and Experimental Medicine. 2026;41(1):132-139. (In Russ.) DOI: 10.29001/2073-8552-2026-41-1-132-139 EDN: JCNJUO

10. Azak E., Cetin I.I. Premature cardiac beats in children with structurally normal heart: autonomic dysregulation. Pediatr. Int. 2021;63(12):1433–1440. DOI: 10.1111/ped.14893

11. Zhu W., Yuan H., Lv J. Advancements in the diagnosis and management of premature ventricular contractions in pediatric patients. Front. Pediatr. 2024;12:1373772. DOI: 10.3389/fped.2024.1373772

12. Rodríguez-Núñez I., Rodríguez-Romero N., Álvarez A., et al. Variabilidad del ritmo cardíaco en pediatría: aspectos metodológicos y aplicaciones clínicas [Heart rate variability in children: methodological issues and clinical applications]. Arch. Cardiol. Mex. 2022;92(2):242–252. Spanish. DOI: 10.24875/ACM.20000473

13. Khazova E. V., Bulashova O. V. significance of determining adrenoreactivity of the body in patients with chronic heart failure. Practical medicine. 2021;19(6):20–25. DOI: 10.32000/2072-1757-2021-6-20-25

14. Manukyan M.A., Falkovskaya A.Yu., Mordovin V.F., Zyubanova I.V., Lichikaki V.A. et al. Beta-adrenergic reactivity of erythrocyte membranes in various phenotypes of uncontrolled hypertension. Russian Journal of Cardiology. 2024;29(5):5668. (In Russ.) DOI: 10.15829/1560-4071-2024-5668 EDN: KCXNTU

15. Rebrova T.Yu., Perevoznikova Yu.E., Muslimova E.F., et al. Erythrocyte membrane adrenoreactivity in children with drug-resistant ventricular extrasystole before and after radiofrequency ablation. Complex Issues of Cardiovascular Diseases. 2024;13(2):6–14. (In Russ.) DOI: 10.17802/2306-1278-2024-13-2-6-14 EDN: XXQSBT

16. Grassi G., Biffi A., Seravalle G., et al. Sympathetic neural overdrive in the obese and overweight state. Hypertension. 2019;74(2):349–358. DOI: 10.1161/HYPERTENSIONAHA.119.12885

17. Perevoznikova Y.E., Svintsova L.I., Rebrova T.Yu., et al. Vegetative state assessment in children with supraventricular arrhythmias before and after radiofrequency ablation. Siberian Journal of Clinical and Experimental Medicine. 2024;39(2):141–148. (In Russ.) DOI: 10.29001/2073-8552-2024-39-2-141-148 EDN: RMRCOP

18. Canale M.P., Manca di Villahermosa S., Martino G., et al. Obesity-related metabolic syndrome: mechanisms of sympathetic overactivity. Int. J. Endocrinol. 2013;2013:865965. DOI: 10.1155/2013/865965