The effect of electro-anatomical mapping on the success rate and fluoroscopy time in supra-ventricular tachycardia ablation in children: single centre retrospective study.

AIMS: To evaluate the effect of electro-anatomical mapping on success rate and fluoroscopy time in ablation of supraventricular tachycardia substrates in a large group of children. METHODS: Patients referred from multiple centres in the Netherlands and who received a first ablation for supraventricular tachycardia substrates in the Leiden University Medical Center between 2014 and 2020 were included in this retrospective cohort study. They were divided in procedures in patients with fluoroscopy and procedures in patients using electro-anatomical mapping. RESULTS: Outcomes of ablation of 373 electro-anatomical substrates were analysed. Acute success rate in the fluoro-group (n = 170) was 95.9% compared to 94.5% in the electro-anatomical mapping group (n = 181) (p = 0.539); recurrence rate was 6.1% in the fluoro-group and 6.4% in the electro-anatomical mapping group (p = 0.911) after a 12-months follow-up. Redo-ablations were performed in 12 cases in the fluoro-group and 10 cases in the electro-anatomical mapping group, with a success rate of 83.3% versus 80.0%, resulting in an overall success rate of 95.9% in the fluoro-group and 92.8% in the electro-anatomical mapping group (p = 0.216) after 12 months. Fluoroscopy time and dose area product decreased significantly from 16.00 ± 17.75 minutes (median ± interquartile range) to 2.00 ± 3.00 minutes (p = 0.000) and 210.5 µGym2 ± 249.3 to 32.9 µGym2 ± 78.6 (p = 0.000), respectively. In the fluoro-group, four complications occurred (2.0%) and in the electro-anatomical mapping group no complications occurred. CONCLUSION: These results demonstrate that ablations of supraventricular tachycardia substrates in children remain a highly effective and safe treatment after the introduction of electro-anatomical mapping as a standard of care, while significantly reducing fluoroscopy time and dose area product.

Wide QRS complex tachycardia with a mysterious mask-Tricuspid isthmus-dependent atrial flutter with preexcitation syndrome and dual atrioventricular nodal pathway conduction.

Key Clinical Message: Atrial flutter (AFL) and supraventricular tachycardia (SVT) are common arrhythmias in clinic. However, some AFL cases may present additional complexities, such as both accessory pathways (AP) and dual atrioventricular node pathways, putting on a mysterious mask and making it challenging to distinguish on electrocardiograms (ECGs). Abstract: A 60-year-old male patient had a sudden syncope, and an ECG showed wide QRS complex tachycardia. This diagnostic ambiguity is further compounded by the fact that SVT via AP conduction can exhibit wide QRS complex tachycardia characteristics resembling ventricular tachycardia (VT). Consequently, a definitive diagnosis through electrophysiological (EP) examination becomes imperative, as it dictates subsequent ablation strategies. In this article, we present a rare case involving three distinct arrhythmias including AFL, AP, and dual atrioventricular node pathways, and successfully treated through ablation.

A Rare and Challenging Case of Refractory Fetal Supraventricular Tachycardia.

Fetal supraventricular tachycardia can be difficult to manage and offers a challenging treatment course, particularly in refractory cases. The treatment course must balance maternal well-being with the health status of the fetus, all while racing against possible progression to hydrops fetalis or permanent cardiac dysfunction. We describe a case of fetal supraventricular tachycardia that demonstrates many of these concepts, as well as the importance of utilizing several treatment pathways in refractory cases.

Clinical course and long-term follow-up of a preterm infant with non-fatal respiratory distress syndrome due to heterozygous ABCA3 gene mutation: A case report and review of literature.

BACKGROUND: Adenosine triphosphate-binding cassette transporter A3 (ABCA3) mutations are recognized as a congenital cause of surfactant deficiency. Clinical presentations of such mutations are largely variable. There are many mutations of the ABCA3 gene, of which, p.E292V is the most common. Despite being the most common ABCA3 gene mutation, there is limited literature on extra pulmonary and long-term outcomes of the affected infants. CASE: We present the case of a Caucasian male infant born at 32 weeks gestation that developed severe respiratory distress shortly after birth, and review published case reports and case series of infants affected with this gene mutation. He was found to have a heterozygous missense mutation p.E292V of ABCA3 resulting in a chronic lung disease. He required multiple courses of systemic and inhalational steroids. He developed supraventricular tachycardia (SVT), feeding problems and hypotonia during his prolonged hospital stay. He demonstrated mild neurodevelopmental delays on follow up at 18 months of age. The chronic lung disease improved over the first 2 years of life. He continued to have feeding difficulties and supraventricular tachycardia at nearly 2 years of age. CONCLUSION: The infant's SVT may be associated with this ABCA3 variant. Further long-term follow-up studies are needed to better characterize extrapulmonary manifestations of this ABCA3 mutation.

Varying physiologic ventricular resynchronization with changes in atrial rhythm in a patient with a right-sided accessory pathway and right bundle branch block.

We describe varying physiologic ventricular resynchronization owing to differences in atrial rhythm in a patient with the right-sided accessory pathway and pre-existing right bundle branch block.

Ventriculoatrial interval variation following atrio-His block during wide-QRS-complex tachycardia with 1:1 ventriculoatrial relationship: What is the diagnosis?

A wide QRS-complex tachycardia with 1:1 ventriculoatrial conduction may present diagnostic difficulties, and multiple pacing maneuvers are often required for an accurate diagnosis. We report a case, in which observation of transient ventriculoatrial interval variation following atrio-His block quickly led to the diagnosis.

Increased heart rate due to supra-ventricular tachycardia triggering premature ventricular contraction.

We describe a case wherein the presence of premature ventricular contractions was related to an increased heart rate that occurred due to supra-ventricular tachycardia: atrial tachycardia or atrioventricular nodal reentry tachycardia.

Analysis on effect of using pre-hospital propafenone emergency treatment for rescuing patients with paroxysmal supraventricular tachycardia / 中国中西医结合急救杂志

Objective To observe the effect of propafenone for patients with paroxysmal supra-ventricular tachycardia (PSVT) during pre-hospital emergency rescue treatment. Methods A retrospective study was conducted. Seventy-six patients with occurrence of PSVT in the process of pre-hospital emergency treatment in Tianjin Hongqiao Hospital from March 2018 to March 2019 were selected. The patients were divided into amiodarone group and propafenone group according to the difference in medications, 38 cases in each group. The effective rate of rescue, the time of recovery of normal heart rate, the total time of treatment, the levels of heart rate before and after treatment and the incidence of adverse reactions were observed in both groups. Results The total effective rate of propafenone group was significantly higher than that of amiodarone group [94.74% (36/38) vs. 73.68% (28/38), P<0.05]. The times of recovery of normal heart rate and total treatment of propafenone group were significantly lower than those of amiodarone group [times of recovery of normal heart rate (hours): 7.14±1.84 vs. 12.56 ± 2.56, times of total treatment (days): 6.14 ± 2.20 vs. 8.87±2.48, both P<0.05].Before treatment, there was no statistical significant difference in heart rate between propafenone group and amiodarone group (hpm: 171.8 ± 24.4 vs. 173.7 ± 25.5, P>0.05), but after treatment, the heart rate of propafenone group was significantly lower than that in amiodarone group (hpm: 112.9±7.5 vs. 138.4 ± 9.0, P<0.05). The incidence of adverse reactions in propafenone group was significantly lower than that of amiodarone group [2.63% (1/38) vs. 15.79% (6/38), P<0.05]. Conclusion Application of propafenone in the pre-hospital emergency treatment of patients with PSVT can effectively improve their clinical efficacy, and its therapeutic safety is high.

Cross Over: A Reliable Maneuver In The Confirmation Of Atrioventricular Nodal Reentrant Tachycardia Ablation.

BACKGROUND: Atrioventricular nodal re-entrant tachycardia (AVNRT) is still the most common presentation to our electrophysiology laboratory for ablation. The aim of this study is to document the confirmative value of cross over manoeuvre in successful AVNRT ablation. METHODS: This study was conducted in Hayat Abad Medical complex Peshawar June 2006 to October 2015. In all patient with AVNRT, Dual-nodal pathway physiology confirmed by programmed atrial pacing of eight Tran with an extra beat by 10 millisecond (ms) decrement and at least Atrial HIS (A-H) interval prolongation of 50 ms. The dual pathway was further confirmed by cross over manoeuvre. Slow pathway potential identified and radiofrequency ablation (RFA) energy applied at 60 temperatures and 30 powers in Left Anterior Oblique (LAO) projection. Post ablation absence of cross over documented with and without isoproterenol and patient followed for any complication or recurrence. RESULTS: Total 567 patients studied with mean age 36.56±12.16 and male to female ratio 1:1.4 with presentation of supraventricular tachycardia (SVT). Slow pathway was successfully modified and statistically no significant complication or recurrence documented. CONCLUSIONS: Failure to cross over reliably excludes any conduction over the slow pathway and so recurrence of AVNRT.

Fluoroless catheter ablation of various right and left sided supra-ventricular tachycardias in children and adolescents.

Electrophysiology study (EPS) and catheter ablation (CA) in children and adolescents carries a potentially harmful effect of radiation exposure when performed with the use of fluoroscopy. Our aim was to evaluate the feasibility, safety and effectiveness of fluoroless EPS and CA of various supra-ventricular tachycardias (SVTs) with the use of the 3D mapping system and intracardiac echocardiography (ICE). Forty-three consecutive children and adolescents (age 13 ± 3 years) underwent fluoroless EPS and CA for various supra-ventricular tachycardias. A three-dimensional (3D) mapping system NavX™ was used for guidance of diagnostic and ablation catheters in the heart. ICE was used as a fundamental imaging tool for transseptal punctures. Acute procedural success rate was 100 %. There were no procedure related complications and short-term follow up (10 ± 3 months) revealed 93 % arrhythmia free survival rate. Fluoroless CA of various SVTs in the paediatric population is feasible, safe and can be performed successfully with 3D mapping system and ICE.

Evaluation of Three Dimensional Electro-anatomical Mapping System in Treating the Patients With Paroxysmal Supra-ventricular Tachycardia by Radio Frequency Catheter Ablation / 中国循环杂志

Objective: To explore the feasibility and safety of three dimensional (3D) electro-anatomical mapping system (Carto3) in treating the patients with paroxysmal supra-ventricular tachycardia (PSVT) by radiofrequency catheter ablation (RCFA). Methods: A total of 180 PSVT patients were divided into 2 groups, n=90 in each group. 3-D group, the patients received RCFA with 3-D reconstructed valve ring model under Carto3 guidance. 2-D group, the patients received RCFA under conventional X-ray guidance. The procedural and X-ray exposure times, rates of success and complications, tachycardia recurrence at 6 months after procedure and the cost were observed and compared between 2 group. Results: The procedural time was similar between 2 groups, P=0.1403. The patients in 3-D group had the lower X-ray exposure time (2.1 ± 0.7 vs 7.8 ± 3.6) min, particularly in those with right-sided accessory pathway (3.4 ± 0.7 vs 20.2 ± 7.1) min, and dual atrio-ventricular (A-V) nodal pathways (1.1 ± 0.3 vs 5.5 ±1.7) min, all P Conclusion: RFCA was feasible for treating PSVT patients under Carto3 guidance, which had the higher success rate with lower X-ray exposure and complication.

Drug therapy considerations in arrhythmias in children.

The understanding of the mechanisms of action and side effects of different antiarrhythmic drugs (AAD) are essential for their appropriate use. With the advent of effective and safe ablation therapy, AAD therapy has undergone dramatic changes. This review attempts to understand the rationale behind the clinical use of medical management of different arrhythmias.