Nonsurgical Transthoracic Mapping and Ablation in a Child with Incessant Ventricular Tachycardia (original) (raw)
Epicardial ablation of tachyarrhythmia in children: Experience at two academic centers
Pacing and Clinical Electrophysiology, 2017
Background: Experience with percutaneous epicardial ablation of tachyarrhythmia in pediatrics is limited. This case series addresses the feasibility, safety and complications of the procedure in children. Methods: A total of 9 patients underwent 10 epicardial ablation procedures from 2002 to 2013 at two academic centers. Activation mapping was performed in all cases, and electro-anatomic map was utilized in 9 of the 10 procedures. Patients had undergone 1-3 failed endocardial catheter ablations in addition to medical management, and all had symptoms, a high-risk accessory pathway (AP), aborted cardiac arrest with Wolff-Parkinson-White syndrome (WPW) or ventricular dysfunction. A standard epicardial approach was used for access in all cases, using a 7 or 8 Fr sheath. Epicardial ablation modality was radiofrequency (RF) in 7, cryoablation (CRYO) in 1, and CRYO plus RF in 1. Results: Median age was 14 (range 8-19) yrs. Indications: drug refractory ectopic atrial tachycardia -1, ventricular tachycardia (VT) -5, high-risk AP -2 and aborted cardiac arrest from WPW -1. Epicardial ablation was not performed in 1 case despite access due to an inability to maneuver the catheter around a former pericardial scar. VT foci included the right ventricular outflow tract septum, high posterior left ventricle (LV), LV outflow tract, postero-basal LV, and scar from previous rhabdomyoma surgery. WPW foci were in the area of the posterior septum and coronary sinus in all 3 cases. Overall procedural success was 70% (7/10), with epicardial ablation success in 5 and endocardial ablation success after epicardial mapping in 2. The VT focus was close to the left anterior descending coronary artery in 1 of the unsuccessful cases in which both RF and CRYO were used. There was 1 recurrence after a successful epicardial VT ablation, which was managed with a second successful epicardial procedure. There were no other recurrences at more than 1 year of follow-up. Complications were minimal, with 1 case of inadvertent pleural access requiring no specific therapy. No pericarditis or effusion was seen in any of the patients who underwent epicardial ablation. Epicardial ablation in pediatric patients can be performed with low complications and acceptable success. It can be considered for a spectrum of tachycardia mechanisms after failed endocardial ablation attempts and suspected epicardial foci. Success and recurrence may be related This article is protected by copyright. All rights reserved. to foci in proximity to the epicardial coronaries, pericardial scar or a distant location from the closest epicardial location. Repeat procedures may be necessary.
Transcatheter Ablation of Supraventricular Tachycardias in Pediatric Patients
Current Pharmaceutical Design, 2008
Ablation has become an important treatment for many pediatric patients with common supraventricular tachycardias (SVTs). Many multicenter studies have documented that radiofrequency (RF) catheter ablation is a safe and effective procedure for treatment of a large variety of SVTs in children and adults with a high success rate and minimal complications. Novel electrophysiology technologies such as electroanatomic mapping and sophisticated ablating catheters have improved success rates and decreased complications of transcatheter ablation. Moreover, within the last several years, a new energy source using cryoenergy has evolved as a safe and effective alternative for catheter ablation for arrhythmogenic substrates traditionally associated with increased risk when using RF ablation. In this review pediatric transcatheter ablation practice is analysed and discussed with reference to current clinical guidelines.
Pediatric Cardiology, 2009
The article describes successful epicardial catheter ablation of ventricular tachycardia using the transpericardial approach in a 14-year-old adolescent. Conventional mapping of endocardial surface revealed criteria consistent with subpericardial localization of arrythmogenic substrate. Epicardial mapping using a transpericardial approach enabled localization and successful elimination of the ventricular tachycardia on the lateral wall of the right ventricle.
Transcatheter ablation of arrhythmias associated with congenital heart disease
Journal of Interventional Cardiac Electrophysiology, 2008
The improvement of surgical techniques resulted in significant life prolongation of many young patients with congenital heart disease (CHD). However, as these patients reach adulthood, their risk for late complications associated with surgery is also increased. One of the most difficult challenges associated with CHD is the high incidence of cardiac arrhythmias that arise from either the myocardial substrate created by abnormal physiology (pressure/volume changes, septal patches, and suture lines) or the presence of surgical scar. Catheter ablation is proven to be effective in treating atrial and ventricular arrhythmias in structurally normal hearts, and has also been used to treat arrhythmias in adults with congenital heart disease. In this review we provide an overview about diagnostic challenges, mapping and ablation techniques and outcome of patients undergoing transcatheter ablation procedures.
The Results of Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children
Pacing and Clinical Electrophysiology, 2007
Backgrounds: Radiofrequency (RF) catheter ablation represents a major advance in the management of children with cardiac arrhythmias and has rapidly become the standard of care for the first-ling therapy of supraventricular tachycardias (SVTs). The purpose of this study was to investigate the results of the RF catheter ablation of SVTs in pediatric patients. Methods: From December 1989 to August 2005, a total of 228 pediatric patients (age: 9 ± 7 years, range: 5-18 years; male:female = 117:111) with clinically documented SVT underwent an electrophysiologic study and RF catheter ablation at our institution. Results: The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 140, 61%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 66, 29%), atrial tachycardia (AT; n = 11, 5%), and atrial flutter (AFL; n = 11, 5%). The success rate of the RF catheter ablation was 92% for AVRT, 97% for AVNRT, 82% for AT, and 91% for AFL, respectively. Procedure-related complications were infrequent (8.7%; major complications: high grade AV block (2/231, 0.9%); minor complications: first degree AV block (6/231, 2.6%), reversible brachial plexus injury (2/231, 0.9%), and local hematomas or bruises (10/231, 4.3%)). The recurrence rate was 4.7% (10/212) during a follow-up period of 86 ± 38 months (0.5-185 months).
Idiopathic ventricular tachycardia in children: curative therapy with radiofrequency ablation
Medicina-lithuania, 2007
Idiopathic ventricular tachycardia is a rare condition, and there is a lack of clear guidelines for the necessity and indications for prophylactic antiarrhythmic or curative treatment. The aim of this study was to review the clinical picture of idiopathic ventricular tachycardia and evaluate the efficacy and safety of radiofrequency ablation therapy in children. Material and methods. The subjects of this study were 16 children with idiopathic ventricular tachycardia. The mean age at onset of idiopathic ventricular tachycardia was 12 years. All patients underwent electrophysiological examination. Nonfluoroscopic mapping technology (Carto TM) was used in one case. Radiofrequency ablation was performed in all children (mean duration of follow-up was 46 months). Results. Six children with idiopathic ventricular tachycardia were free of symptoms. Palpitation was the only complain in four patients, and six patients presented with symptoms of circulatory disorder (the tendency of the higher rate of ventricular tachycardia and more premature contractions and episodes of ventricular tachycardia in one day were noticed in five of them). All children after radiofrequency ablation were alive, and only one complication (complete right bundle branch block) occurred. Success at last follow-up included five children with left and six with right idiopathic ventricular tachycardia. Conclusions. Catheter ablation seems a promising therapeutic option with the outlook possible of the idiopathic ventricular tachycardia in children. It is safe enough and should be considered as the therapy of choice even in children without of symptoms if they wish to live active social and physical life.
Radiofrequency Catheter Ablation of Tachycardia in Patients with Congenital Heart Disease
Pediatric Cardiology, 2000
Patients with anomalies of the heart frequently suffer from arrhythmias that either are associated with a congenital heart defect or result from the course of the disease. For most of the bradyarrhythmias, appropriate timing of the initiation of treatment is more challenging than its eventual execution. In the case of tachycardias, technical aspects of treatment require more attention because the often imperative impact such tachycardias have on quality of life, morbidity, and mortality determine intervention timing. Increasingly, interventional electrophysiology is turned to as a potentially definitive and substrate-related treatment because of antiarrhythmic drug therapy's failure to prevent arrhythmia recurrences and the potential detrimental side effects from drug therapy seen in this particular patient population. Using the experience gained during the past 10 years in the treatment of patients with arrhythmias but without associated structural heart disease, several groups reported their results and difficulties with the application of such therapy to patients with congenital heart defects. In this report, we summarize our hospital's experience with transcatheter radiofrequency current application for treatment of various types of tachyarrhythmias in 139 children and adults with congenital heart defects, emphasizing the current limitations of such therapy and addressing the potential benefits expected from future technology. Patient ages ranged from 5 months to 76 years (mean 25.3 ± 17.7 years), including 56 children and adolescents less than 16 years of age. At least one attempt at surgical palliation or correction was made in 93 patients; the remaining 46 patients had no surgical intervention attempts. A total of 225 different tachycardias were found, 93 of which were based on a congenital arrhythmogenic substrate (e.g., an accessory pathway). Acquired substrates (e.g., scars or myocardial fibrosis) gave rise to the remaining 132 tachycardias. Radiofrequency current ablation (183 sessions) successfully treated 121 of 139 patients. Within a follow-up period of 21 months a recurrence of the intrinsically treated tachycardia was seen in 24 patients (10.7%); 13 of the 24 underwent a successful repeat session. There were no significant pro-cedure-related complications. Young and adult patients with congenital heart disease can be safely and successfully treated for tachycardias with the use of radiofrequency current ablation. Because such treatment meets the specific needs of this patient group, early consideration for this therapy is recommended.
Cureus, 2020
Background Arrhythmias are one of the reasons for emergency hospitalization among the pediatric population. Radiofrequency ablation is a major advancement in the management of children with cardiac arrhythmias. Objectives Our study was designed to describe the outcomes of catheter ablation in the pediatric population for atrial and ventricular arrhythmias in our center. Methods All patients between two and 18 years of age undergoing radiofrequency ablation after failed medical management for arrhythmias in our institute were included. Age less than two years, no previous medical management, and complex congenital heart disease were excluded. Baseline and electrophysiological characteristics were recorded. The patients were followed up for a clinical or electrocardiographic recurrence of arrhythmia. Results Thirty-six patients were included (mean age 12.8 ± 3.9 years (range 2-18 years), male 56%, average weight 36.39 ± 11.02 kg). The mean follow-up duration was 27.7 ± 15.9 months (range 3-58). Five-point five percent (5.5%) had tachycardiomyopathy. The arrhythmias included (1) atrioventricular nodal re-entrant tachycardia (AVNRT, n=16, 44%), (2) atrioventricular reciprocating tachycardia (AVRT, n=14, 39%), (3) atrial tachycardia (AT, n=2, 5.5%), (4) ventricular premature complexes (VPCs, n=2, 5.5%), (5) atrial flutter (AFL, n=1, 3%), and (6) ventricular tachycardia (VT, n=1, 3%). A transeptal puncture was done in 10 patients (28%). 3D mapping was done in six patients. The mean radiofrequency (RF) pulses were 2.3 ± 1.3. The acute procedural success rate was 100%. The long-term success was 97.2%. One (2.7%) developed recurrence. No major complications were reported. Conclusion Catheter ablation in the pediatric population is a safe procedure and can be done with more feasibility and fewer complications when done in experienced hands.