Non-fluoroscopic Techniques for Catheter Ablation of Typical Atrioventricular Nodal Re-entry Tachycardia in a Pediatric Patient with Atypical Venous Anatomy (original) (raw)
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Catheter Ablation of Pediatric Atrioventricular Nodal Re-entrant Tachycardia
Journal of Innovations in Cardiac Rhythm Management, 2020
Catheter ablation is considered as the standard treatment for all patients with symptomatic drug-refractory tachyarrhythmia. The safety and efficacy of the procedure in the adult population is well-established. Due to the small size of the patient and difficulty in attaining venous access, infants are rarely subjected to radiofrequency ablation. Here, we report a case of drug-refractory AV nodal re-entrant tachycardia in a two-year-old child. Radiofrequency ablation was performed with a 5-Fr sized medium-curve ablation catheter deployed at the slow pathway region where a fractionated A-wave with slow-pathway potential was recorded. After ablation, no recurrence of SVT at the end of 12 months of follow-up was observed.
International Journal of Cardiology, 2007
Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia in adulthood. Although selective ablation of the slow AV nodal pathway can cure AVNRT, accidental AV block may occur. The details on the electrophysiologic characteristics, quantitative data on the voltage inside Koch's triangle, and the use of three-dimensional noncontact mapping to facilitate the catheter ablation of AVNRT associated with a high-risk for AV block or other arrhythmias have been limited. Methods and results: Nine patients (M/F = 5/4, 34 ± 23 years, range 17-76) with clinically documented AVNRT were included. All patients had undergone previous sessions for slow AV nodal pathway ablation but they had failed, because of repetitive episodes of complete AV block during the RF energy applications. Further, one patient had a complex anatomy and 4 patients were associated with other tachycardias, respectively. The electrophysiologic studies revealed that 4 patients had the slow-fast, 4 the slow-intermediate and one the fast-intermediate form of AVNRT.
Circulation. Arrhythmia and electrophysiology, 2017
The relationship of atrioventricular nodal reentrant tachycardia to congenital heart disease (CHD) and the outcome of catheter ablation in this population have not been studied adequately. A multicenter retrospective study was performed on patients with CHD who had atrioventricular nodal reentrant tachycardia and were treated with catheter ablation. There were 109 patients (61 women), aged 22.1±13.4 years. The majority, 86 of 109 (79%), had CHD resulting in right heart pressure or volume overload. Patients were divided into 2 groups: group A (n=51) with complex CHD and group B (n=58) with simple CHD. There were no significant differences between groups in patients' growth parameters, use of 3-dimensional imaging, and type of ablation (radiofrequency versus cryoablation). Procedure times (251±117 versus 174±94 minutes; P=0.0006) and fluoroscopy times (median 20.8 versus 16.6 minutes; P=0.037) were longer in group A versus group B. There were significant differences between groups...
Circulation-arrhythmia and Electrophysiology, 2016
C atheter ablation of the slow conducting pathway (SP) of the atrioventricular (AV) node is the recommended treatment for AV nodal reentrant tachycardia (AVNRT) in children and adults. With both radiofrequency and cryoenergy, high procedural success rates of 98% to 100% have been reported. 1,2 In adult patients, freedom from AVNRT has been achieved in 95% after radiofrequency ablation and in 90% after the use of cryoenergy 1 year after the initial ablation procedure. 3 In children and adolescents, data from the pediatric radiofrequency catheter ablation registry acquired more than a decade ago reported a significant number of recurrences with 71% freedom from AVNRT 3 years post ablation. 4 However, recent follow-up studies of pediatric patients after AVNRT ablation reported freedom from AVNRT between 84% and 100% with radiofrequency 2,5 and between 78% and 93% with cryoenergy, 6-8 respectively. These studies on a limited number of pediatric patients analyzed data on the follow-up of 1 to 3 years post ablation. Little information on the course beyond 3 years after AVNRT ablation in pediatric patients has been published. The purpose of the present study was to evaluate the longterm course of pediatric patients after AVNRT ablation at our institution. Foci of interest were (1) impact of the primary procedural end point (SP ablation versus SP modulation) on long-term success, (2) impact of body weight on long-term safety and success, (3) incidence and timing of late AVNRT recurrence, and (4) incidence of late AV block or new tachyarrhythmias attributable to AVNRT ablation. See Editorial by Kirsh Methods Patients Between October 2002 and May 2014, a total of 249 children and adolescents <18 years of age had undergone catheter ablation for AVNRT at our institution. Procedural data and primary success rates and acute complications have recently been published. 1 Patients, in whom AVNRT ablation failed (n=5), were not enrolled into the present study: although a repeat ablation was offered for all 5 subjects with procedural failure, 3 out of 5 patients were lost during follow-up and 1 individual decided against a repeat procedure. Additionally, 3 patients with permanent AV block immediately after radiofrequency ablation (n=3) 1 were excluded. Finally, follow-up data ≥1 year after AVNRT ablation of 241 patients were included into this study. Follow-up data of patients after primary AVNRT ablation procedures were exclusively considered to avoid bias by including follow-up
Catheter Ablation of Atypical Atrioventricular Nodal Reentrant Tachycardia
Circulation, 2016
Background: Because of its low prevalence, data on atypical atrioventricular nodal reentrant tachycardia (AVNRT) are scarce, and the optimal ablation method has not been established. Our study aimed at assessing the efficacy and safety of conventional slow pathway ablation, as applied for typical cases, in atypical AVNRT. Methods: We studied 2079 patients with AVNRT subjected to slow pathway ablation. In 113 patients, mean age 48.5±18.1 years, 68 female, atypical AVNRT or coexistent atypical and typical AVNRT without other concomitant arrhythmia was diagnosed. Ablation data and outcomes were compared with a group of age- and sex-matched control patients with typical AVNRT. Results: Fluoroscopy and radiofrequency current delivery times were not different in the atypical and typical groups, 20.3±12.2 versus 20.8±12.9 minutes ( P =0.730) and 5.9±5.0 versus 5.5±4.5 minutes ( P =0.650), respectively. Slow pathway ablation was accomplished from the right septum in 110 patients, and from t...
Europace, 2009
functional class III. An echocardiogram demonstrated a left ventricular ejection fraction of 30%. His electrocardiogram showed a ventricular paced rhythm with left bundle branch block morphology. In view of this, he was put forward for upgrade to a biventricular ICD. The new device was implanted in the existing left-sided pocket. Venous access was gained via the left subclavian vein and an active lead (5568 Medtronic, Minneapolis, MN, USA) inserted through a left-sided superior vena cava into the anterior wall of the right atrium. The coronary sinus (CS) was cannulated using a 9 F Attain 6216A-MB2 guide catheter (Medtronic) with fluoroscopy in the right anterior oblique (RAO) projection. A venogram demonstrated a suitable posterior vein (Figure 1A) and a bipolar left ventricular lead (Attain 4194, Medtronic) was advanced into a suitable position with satisfactory pacing parameters (Figure 1B). There were no complications. The final position of the leads is shown in Figure 1C and D. At 4-month follow-up, the patient was well, his heart failure symptoms had improved to NYHA class II, and the lead parameters were stable. Discussion Dextrocardia is a congenital abnormality where the heart is located in the right hemithorax, as a result of abnormal embryological cardiac development. It is rare, with an incidence of 0.4 per 10 000 live births. 1 Approximately one-third of the cases are associated with situs inversus, where the major visceral organs, including the heart, are a mirror image of their normal position. 1 Although dextrocardia with situs inversus may occur in association with other congenital cardiac anomalies, it can be an isolated finding with normal life expectancy. 1 Patients with congenital heart disease may have coexistent CAD and conventional indications for device therapy. However, the implantation of transvenous leads can be technically challenging and the approach needs to be tailored to the patient's individual anatomy. Our case demonstrates that in patients with isolated dextrocardia and situs inversus, the CS can be accessed and a left ventricular lead inserted using a conventional approach and standard equipment. In contrast, in cases of dextrocardia and situs inversus associated with other congenital cardiac defects, transvenous CRT can be much more challenging. 2 The only important difference to note is that when imaging the CS, the RAO view serves as the equivalent of a left anterior oblique projection in the normal heart. In our case, venous access was gained from the left side, making use of the existing lead and pocket. It could be argued that a rightsided implant may make CS cannulation more straightforward, as well as providing a more effective shocking vector, and if attempting a new device implant in such patients, we would advocate such an approach.
Journal of Interventional Cardiac Electrophysiology, 2007
We present a case of a 21-year-old female with congenitally corrected transposition of the great vessels and episodes of supraventricular tachycardia. We performed an electrophysiological study and successful ablation using an electro-anatomical mapping system. A single His bundle appeared to be located at the apex of the triangle of Koch and at electrophysiological study there was evidence of triple antegrade AV nodal pathways-slow, intermediate and fast, with two types of AV nodal re-entrant tachycardias. A series of radiofrequency ablations in the right posteroseptal area eliminated both slow and intermediate pathway conduction and cured the tachycardias.
Medicina (Kaunas, Lithuania), 2009
Radiofrequency ablation of the slow pathway is an effective method of treatment in children with atrioventricular nodal reentrant tachycardia. The aim of our study was to evaluate anterograde conduction properties in children before and after radiofrequency ablation of the slow pathway and to determine the efficacy and safety of this method. Noninvasive transesophageal electrophysiological examination was performed in 30 patients at the follow-up period (mean duration, 3.24 years) after radiofrequency ablation of the slow pathway. The slow pathway function was observed in 13 patients one day after ablation, in 26 patients during the follow-up period, and in 28 patients after administration of atropine sulfate. Atrioventricular node conduction was significantly decreased the following day after ablation and at the follow-up versus the preablation (165.2 [30.2] bmp and 146.3 [28.5] bpm versus 190.9 [31.4] bpm; P<0.001). The atrioventricular node effective refractory period prolonge...
Pacing and Clinical Electrophysiology, 1999
Ablation of Common Atrioventricular Nodal Reentrant Tachycardia./w^e tested the hypothesis that in some patients affected by typical AVNRT, successful catheter ablation treatment may be achieved independently of specific measurable electrophysiological modifications of antegrade AV node conducting properties. Standard electrophysiological parameters and comparable antegrade AV node function curves were obtained, before and after successful ablation, in 104 patients (mean age 52 ± 16 years; 69 women and 35 men) affected by the common form of AVNRT. The end point ofthe ablation procedure was noninducibility of AVNRT and of no more than one echo beat. For the purpose of this study, AVnode duality was defined as an increase of ^ 50 ms in the A2H2 interval in response to a 10 ms decrease ofthe A1A2 coupling interval. Refore ablation, AV node duality was present in 65 patients (62%) and absent in 39 patients (37%). Ablation caused measurable modifications of electrophysiological properties oftheAV node in most patients with elicited AV node duality, but not in most patients without demonstrable AV node duality. After ablation, AV node duality persisted in 20 patients who had it before, whereas a new duality that could not be elicited before appeared in 5 patients. During 19 ± 6 months of follow-up, clinical AVNRT recurred in 1 of 45 patients who had disappearance of AVnode duality after ablation, in 1 of 34 patients who did not show AV node duality before and after ablation, and in 1 of 20 patients who had persistence of AVnode duality after ablation. In conclusion, modifications of antegrade conduction properties of the AVnode are not crucial for the cure of AVNRT in many patients/ (PACE 1999; 22:263-267) AV nodal reentrant tachycardia, slow pathways, catheter ablation, electrophysiological study