RESUMEN
Block in accessory pathway (AP) conduction with adenosine has been previously described. However, conduction characteristics of these APs has not been well defined to date. All patients with APs = 21 years old who underwent an EP study from 2014 to 2017 were included in our study. Patients with adenosine sensitive APs were identified (group 1). Demographic and AP conduction characteristics were compared between group 1 and the entire cohort of patients. Local atrioventricular (AV) or ventriculoatrial (VA) time, cycle length and need for isoproterenol were compared to a control group matched by age and AP location (group 2). Student's t test, Wilcoxon rank sum, χ2 and Fisher's exact were used for analysis. Fourteen (7%) out of 207 patients had an adenosine sensitive AP. The median age of patients with adenosine sensitive APs was 11.8 (IQR 8.5-13.5) years vs. 14 (IQR 10.6-16.7) for the rest of the cohort (p = 0.04). Three of the 134 patients with preexcitation had adenosine sensitive APs (2%) vs. 11 of the 73 patients with concealed APs (15%) (p = 0.001). The median local AV/VA time at the site of successful ablation was longer in group 1 vs group 2 [78 ms, IQR 62-116 vs. 31 ms, IQR 30-38; p < 0.001]. Antegrade AP effective refractory period and total procedure time were longer in patients with adenosine sensitive APs (p = 0.03 & p = 0.04, respectively). Adenosine sensitive APs which occur in children are more often concealed. These APs have a longer conduction time at the site of successful ablation.
Asunto(s)
Fascículo Atrioventricular Accesorio/cirugía , Adenosina/farmacología , Ablación por Catéter/métodos , Electrocardiografía/métodos , Frecuencia Cardíaca/fisiología , Síndromes de Preexcitación/cirugía , Fascículo Atrioventricular Accesorio/tratamiento farmacológico , Fascículo Atrioventricular Accesorio/fisiopatología , Adolescente , Antiarrítmicos/farmacología , Niño , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Masculino , Síndromes de Preexcitación/fisiopatologíaRESUMEN
Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.
Asunto(s)
Fascículo Atrioventricular Accesorio/diagnóstico por imagen , Fascículo Atrioventricular Accesorio/tratamiento farmacológico , Cardiomiopatía Dilatada/diagnóstico por imagen , Flecainida/uso terapéutico , Síndrome de Wolff-Parkinson-White/diagnóstico por imagen , Fascículo Atrioventricular Accesorio/complicaciones , Cardiomiopatía Dilatada/tratamiento farmacológico , Cardiomiopatía Dilatada/etiología , Cardiomiopatía Dilatada/terapia , Ecocardiografía Doppler/métodos , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Lactante , Inyecciones Intravenosas , Masculino , Medición de Riesgo , Muestreo , Resultado del Tratamiento , Síndrome de Wolff-Parkinson-White/complicaciones , Síndrome de Wolff-Parkinson-White/fisiopatologíaAsunto(s)
Adenosina/farmacología , Sistema de Conducción Cardíaco/efectos de los fármacos , Sistema de Conducción Cardíaco/diagnóstico por imagen , Imagenología Tridimensional/métodos , Taquicardia Supraventricular/diagnóstico por imagen , Fascículo Atrioventricular Accesorio/diagnóstico por imagen , Fascículo Atrioventricular Accesorio/tratamiento farmacológico , Electrocardiografía/métodos , Electrofisiología/métodos , Femenino , Humanos , Masculino , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: The aim of this study was to evaluate the indications, results and complications of radiofrequency ablation (RFA) and transcatheter cryoablation (TCA) in neonates and infants with incessant drug-resistant supraventricular tachycardia (SVT). METHODS: Out of 225 patients who underwent RFA and TCA at our center between January2010 and February 2012, 5 patients under the age of 1 (4 male, 1 female) were evaluated. The indication for RFA/TCA was recurrent hemodynamically compromising drug-resistant SVT. RESULTS: Over a 2-year period, 6 ablation procedures were performed in 5 patients. Average patient age was 3.3 ± 3.9 months (12 days - 9.5 months); average patient weight was 5.4 ± 2.2 kg (3.5-9 kg). One patient had ventricular septal defect, 1 had corrected transposition of great arteries, ventricular septal defect, right ventricular hypoplasia and pulmonary hypertension, while 3 had only patent foramen ovale. Electrophysiology study showed 1 accessory pathway in each patient (right posteroseptal in 2, left posteroseptal in 2 and left lateral in 1). The pathway was manifest in 1 patient with Wolff-Parkinson-White syndrome (WPW) and concealed in the rest. Two of the concealed pathways had slow conduction time and decremental properties (the permanent form of junctional reciprocating tachycardia). Two patients underwentTCA and 3 - RFA, with an acute success rate of 100%. In the first week after the procedure, the patient with the complex cardiac anomaly and WPW developed recurrence and under went ablation again. Four of the procedures were carried out using an electroanatomic mapping system besides fluoroscopy. Average procedure time was 167 min (100-234); fluoroscopy time was 8.2 min (0.7-19.7). None of the patients developed major complications. After the average follow-upperiod of 6.5 months (3-18), all patients were symptom-free without medication. CONCLUSIONS: RFA and TCA can be performed successfully in neonates and infants within cessant medically refractory SVT.
Asunto(s)
Antiarrítmicos/uso terapéutico , Ablación por Catéter , Criocirugía , Taquicardia Supraventricular/cirugía , Fascículo Atrioventricular Accesorio/diagnóstico , Fascículo Atrioventricular Accesorio/tratamiento farmacológico , Fascículo Atrioventricular Accesorio/cirugía , Ablación por Catéter/efectos adversos , Criocirugía/efectos adversos , Resistencia a Medicamentos , Femenino , Hemodinámica , Humanos , Lactante , Recién Nacido , Masculino , Recurrencia , Reoperación , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/tratamiento farmacológico , Taquicardia Supraventricular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/tratamiento farmacológico , Síndrome de Wolff-Parkinson-White/cirugíaRESUMEN
AIMS: Verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) combined with a left accessory pathway (AP) is a relatively rare condition. This study examines the characteristics of patients with this condition and the effect of radiofrequency catheter ablation (RFCA). METHODS AND RESULTS: Catheter ablation was performed on 140 ILVT patients at a single centre from January 2004 to December 2009. A concealed left AP was found in seven patients (5%), all of whom were male, with an average age of 21 ± 9 years. Sustained ILVT and orthodromic atrioventricular reentrant tachycardia (AVRT) were induced in all seven patients. Retrograde activation through a bystander AP occurred concomitantly with ILVT, with an average tachycardia length of 346 ± 29 ms (range 310-400 ms). The location of the APs in four patients was left posterior, two of which showed a slow and decremental property, while in three it was left lateral. Ablation via a retrograde transaortic approach was performed in the seven patients. The left AP was ablated first in six patients, but ILVT was no longer induced in one and became non-sustained in another. In the seventh patient, ILVT was ablated first and this proved successful. CONCLUSIONS: Among patients with IVLT, 5% had a concomitant left AP, most of who were young men. The location of the left AP was mainly posterior and lateral, with 30% showing a slow and decremental property. Idiopathic left ventricular tachycardia and AP should be ablated simultaneously.