Assuntos
Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/terapia , Cardiopatias Congênitas/epidemiologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/prevenção & controle , Terapia de Ressincronização Cardíaca , Ablação por Cateter , Comorbidade , Desfibriladores Implantáveis , Técnicas Eletrofisiológicas Cardíacas , Acessibilidade aos Serviços de Saúde , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/cirurgia , Humanos , Marca-Passo ArtificialAssuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/terapia , Adulto , American Heart Association/organização & administração , Canadá , Eletrofisiologia Cardíaca/organização & administração , Terapia de Ressincronização Cardíaca , Cardiologia/organização & administração , Ablação por Cateter , Criança , Desfibriladores Implantáveis , Técnicas Eletrofisiológicas Cardíacas , Europa (Continente) , Humanos , Marca-Passo Artificial , Estados UnidosRESUMO
The relationship between accessory pathway-mediated ventricular preexcitation and left ventricular dyssynchrony-induced dysfunction has been described in patients with Wolff-Parkinson-White (WPW) syndrome in the absence of sustained supraventricular tachycardia (SVT). Supraventricular tachycardia in infants is usually successfully suppressed with antiarrhythmic medications, but catheter ablation has ultimately been required as definitive treatment in medically resistant cases. Catheter ablation has not been described in young infants for dyssynchrony-related dilated cardiomyopathy in the absence of SVT. We describe a case of an infant with WPW who did not have sustained supraventricular tachycardia, but who developed rapid progression of ventricular dysfunction after birth. Preexcitation could not be medically suppressed but was successfully ablated. This was followed by complete resolution of ventricular dysfunction within 2 months.
Assuntos
Cardiomiopatia Dilatada/etiologia , Ablação por Cateter , Síndrome de Wolff-Parkinson-White/cirurgia , Cardiomiopatia Dilatada/diagnóstico , Cardiomiopatia Dilatada/fisiopatologia , Ecocardiografia , Eletrocardiografia , Técnicas Eletrofisiológicas Cardíacas , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Lactente , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologiaAssuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Sistema de Condução Cardíaco/fisiopatologia , Frequência Cardíaca , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/cirurgia , Estimulação Cardíaca Artificial , Ablação por Cateter , Desfibriladores Implantáveis , Técnicas Eletrofisiológicas Cardíacas , Educação em Saúde , Política de Saúde , Parada Cardíaca/etiologia , Parada Cardíaca/prevenção & controle , Humanos , Sociedades Médicas , Volume SistólicoRESUMO
INTRODUCTION: A multicenter prospective study was designed and implemented to assess the short- and longer-term results and risks associated with radiofrequency (RF) ablation in children. METHODS AND RESULTS: Patients recruited for the study were aged 0 to 16 years with supraventricular tachycardia due to accessory pathways or AV nodal reentrant tachycardia (AVNRT), excluding patients with nontrivial congenital heart disease. A national registry also was established, and contributing centers were encouraged to enroll all pediatric patients, aged 0 to 21 years, undergoing ablation at their center. This report summarizes acute results of these procedures. For analysis, subjects were divided into three groups: the prospective cohort (n = 481), cohort-eligible registry participants (n = 504), and not cohort eligible registry participants (n = 1,776). Prospectively enrolled cohort patients were similar to cohort-eligible patients in terms of demographic and other patient characteristics. Overall success rates for RF ablation were high (95.7%), with higher success rates for left-sided and particularly left free-wall pathways (97.8%) than right free-wall pathways (90.8%). Complications of both electrophysiologic study and RF ablation were infrequent (4.2% and 4.0%, respectively), and there were no deaths. AV block was uncommon overall (1.2%) and was limited to ablation in AVNRT (2.1%) and septal accessory pathways (3.0%). CONCLUSION: Despite the multicenter and prospective design, the study demonstrates high success rates and low complication rates, which are comparable to prior single-center retrospective studies. These results may serve as the current best benchmark for expected results in the pediatric population, aged 0 to 16 years, both in terms of acute success rates and the occurrence of complications.