Successful Catheter Ablation in an Infant With Multiple Accessory Pathways and Incessant Arrhythmia

Document Type : Case Report

Authors

1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Department of Cardiac Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Wolff–Parkinson–White (WPW) syndrome is a common cause of supraventricular tachycardia encountered in childhood. We herein describe a 2-month-old male infant with paroxysmal supraventricular tachycardia that was refractory to multiple antiarrhythmic medications. The diagnosis of orthodromic reciprocating tachycardia over multiple accessory pathways was confirmed by meticulous mapping. One of the accessory pathways was located in the mid-septal region, and it acted as the retrograde limb in the arrhythmia circuit. The other accessory pathway was located in the right free-wall region, and it intermittently acted as the antegrade limb of the arrhythmia. Ablating the mid-septal accessory pathway eliminated the arrhythmia. (Iranian Heart Journal 2021; 22(2): 119-123)

Keywords

References

  1. Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, et al. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm. 2016 Jun; 13(6):e251-89.
  2. Calkins H, Langberg J, Sousa J, el-Atassi R, Leon A, Kou W, et al. Radiofrequency catheter ablation of accessory atrioventricular connections in 250 patients. Circulation. 1992 Apr; 85(4):1337-46.
  3. Paul T, Bertram H, Bökenkamp R, Hausdorf G. Supraventricular tachycardia in infants, children and adolescents: diagnosis, and pharmacological and interventional therapy. Paediatr Drugs. 2000 May-Jun; 2(3):171-81.
  4. Dalili M, Rao JY, Brugada P. Radiofrequency ablation of accessory pathways in children with complex congenital cardiac lesions: A report of three cases. J Tehran Heart Cent. 2013 Apr; 8(2):111-5
  5. Sealy WC, Gallagher JJ. Surgical problems with multiple accessory pathways of atrioventricular conduction. J Thorac Cardiovasc Surg. 1981 May; 81(5):707-12.
  6. Bardy GH, Packer DL, German LD, Gallagher JJ. Preexcited reciprocating tachycardia in patients with Wolff-Parkinson-White syndrome: incidence and mechanisms. Circulation. 1984 Sep; 70(3):377-91.
  7. Weindling SN, Saul JP, Walsh EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. Am Heart J. 1996 Jan; 131(1):66-72.
  8. Chiu SN, Lu CW, Chang CW, Chang CC, Lin MT, Lin JL, et al. Radiofrequency catheter ablation of supraventricular tachycardia in infants and toddlers. Circ J. 2009 Sep; 73(9):1717-21.
  9. Selle JG, Sealy WC, Gallagher JJ, Fedor JM, Svenson RH, Zimmern SH. Technical considerations in the surgical approach to multiple accessory pathways in the Wolff-Parkinson-White syndrome. Ann Thorac Surg. 1987 Jun; 43(6):579-84.
  10. Yeh SJ, Wang CC, Wen MS, Lin FC, Wu D. Radiofrequency ablation in multiple accessory pathways and the physiologic implications. Am J Cardiol. 1993 May 15; 71(13):1174-80.
  11. Gallagher JJ, Sealy WC, Kasell J, Wallace AG. Multiple accessory pathways in patients with the pre-excitation syndrome. Circulation. 1976 Oct; 54(4):571-91.
  12. Miyazaki A, Blaufox AD, Fairbrother DL, Saul JP. Cryo-ablation for septal tachycardia substrates in pediatric patients: mid-term results. J Am Coll Cardiol. 2005 Feb 15; 45(4):581-8.
  13. LaPage MJ, Saul JP, Reed JH. Long-term outcomes for cryoablation of pediatric patients with atrioventricular nodal reentrant tachycardia. Am J Cardiol. 2010 Apr 15; 105(8):1118-21.
  14. Collins KK, Dubin AM, Chiesa NA, Avasarala K, Van Hare GF. Cryoablation versus radiofrequency ablation for treatment of pediatric atrioventricular nodal reentrant tachycardia: initial experience with 4-mm cryocatheter. Heart Rhythm. 2006 May; 3(5):564-70. Epub 2006 Feb 28.
Iranian Heart Journal
Volume 22, Issue 2
April 2021
Pages 119-123

Files

Share

How to cite

Statistics