Europace Advance Access published October 12, 2016
EP CASE EXPRESS
doi:10.1093/europace/euw172
.............................................................................................................................................................................
Successful radiofrequency catheter ablation for ventricular tachycardia of a 2.9 kg infant with Ebstein’s anomaly Naoki Takeshita1*, Yo Kajiyama1, Yuma Morishita1, Toshiyuki Itoi1, Masaaki Yamagishi2, and Tsugutoshi Suzuki3 1
Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and 3 Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan 2
* Corresponding author. Tel: +81 75 251 5832; fax: +81 75 251 5833, E-mail address: [email protected] Case
The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/ Electrophysiology/EP-Case-Reports. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
Downloaded from by guest on October 18, 2016
mm/mV 5 mm/mV B A 39-day-old female infant with Ebstein’s anomaly, A 10 RAO 30° 25 mm/s 25 mm/s 220 bpm pulmonary atresia, atrial septal defect, and patent ductus arteriosus developed repetitive critical venV1 I tricular tachycardia (VT) ranging from 200 to 240 bpm. We assumed the focal VT originated from the right ventricle (RV) from the electrocarV2 diographic features. Pharmacological therapies and overdrive pacing were ineffective. Her cardioII V3 vascular status gradually deteriorated, so radiofrequency catheter ablation (RFCA) was performed III at 46 days old, weighed only 2.9 kg, under general anaesthesia and mechanical ventilation. We approached the RV via the right internal jugular vein V4 with 5-Fr sheath puncture. The earliest activation aVR site was identified using bipolar electrograms and RFCA up to 608C and 20 W for 60 s at the outflow tract of the RV terminated the arrhythmia. VenV5 tricular tachycardia recurred at 62 days old and was terminated by RFCA. Three weeks later, aVL Starnes’ procedure, RV exclusion, division of the ductus arteriosus, construction of the BlalockTaussig shunt, and intraoperative cryoablation V6 for residual muscle of the excluded RV were per- aVF formed. She was discharged without anti-arrhythmic agents. Radiofrequency catheter ablation in small infants with congenital heart defects is challenging. Hence, pharmacological treatment is preferable to catheter ablation. In this case, however, RFCA was attempted as the final option because the pharmacological and pacing therapies could not manage the cardiovascular status.
EP CASE EXPRESS
doi:10.1093/europace/euw172
.............................................................................................................................................................................
Successful radiofrequency catheter ablation for ventricular tachycardia of a 2.9 kg infant with Ebstein’s anomaly Naoki Takeshita1*, Yo Kajiyama1, Yuma Morishita1, Toshiyuki Itoi1, Masaaki Yamagishi2, and Tsugutoshi Suzuki3 1
Department of Pediatric Cardiology and Nephrology, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; Department of Pediatric Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan; and 3 Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital, 2-13-22, Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan 2
* Corresponding author. Tel: +81 75 251 5832; fax: +81 75 251 5833, E-mail address: [email protected] Case
The full-length version of this report can be viewed at: http://www.escardio.org/Guidelines-&-Education/E-learning/Clinical-cases/ Electrophysiology/EP-Case-Reports. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2016. For permissions please email: [email protected].
Downloaded from by guest on October 18, 2016
mm/mV 5 mm/mV B A 39-day-old female infant with Ebstein’s anomaly, A 10 RAO 30° 25 mm/s 25 mm/s 220 bpm pulmonary atresia, atrial septal defect, and patent ductus arteriosus developed repetitive critical venV1 I tricular tachycardia (VT) ranging from 200 to 240 bpm. We assumed the focal VT originated from the right ventricle (RV) from the electrocarV2 diographic features. Pharmacological therapies and overdrive pacing were ineffective. Her cardioII V3 vascular status gradually deteriorated, so radiofrequency catheter ablation (RFCA) was performed III at 46 days old, weighed only 2.9 kg, under general anaesthesia and mechanical ventilation. We approached the RV via the right internal jugular vein V4 with 5-Fr sheath puncture. The earliest activation aVR site was identified using bipolar electrograms and RFCA up to 608C and 20 W for 60 s at the outflow tract of the RV terminated the arrhythmia. VenV5 tricular tachycardia recurred at 62 days old and was terminated by RFCA. Three weeks later, aVL Starnes’ procedure, RV exclusion, division of the ductus arteriosus, construction of the BlalockTaussig shunt, and intraoperative cryoablation V6 for residual muscle of the excluded RV were per- aVF formed. She was discharged without anti-arrhythmic agents. Radiofrequency catheter ablation in small infants with congenital heart defects is challenging. Hence, pharmacological treatment is preferable to catheter ablation. In this case, however, RFCA was attempted as the final option because the pharmacological and pacing therapies could not manage the cardiovascular status.
