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Cardiology Journal 2013The aim of this study was to evaluate the indications, results and complications of radiofrequency ablation (RFA) and transcatheter cryoablation (TCA) in neonates and...
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.
Topics: Accessory Atrioventricular Bundle; Anti-Arrhythmia Agents; Catheter Ablation; Cryosurgery; Drug Resistance; Female; Hemodynamics; Humans; Infant; Infant, Newborn; Male; Recurrence; Reoperation; Tachycardia, Supraventricular; Time Factors; Treatment Outcome; Wolff-Parkinson-White Syndrome
PubMed: 23788297
DOI: 10.5603/CJ.2013.0068 -
International Journal of Medical... 2023Radiofrequency catheter ablation (RFCA) is a safe and effective treatment for paroxysmal supraventricular tachycardia in adults. However, data on its use in children,...
Radiofrequency catheter ablation (RFCA) is a safe and effective treatment for paroxysmal supraventricular tachycardia in adults. However, data on its use in children, particularly from low- and middle-income countries, are limited. This study aimed to evaluate the safety and efficacy of RFCA in children with paroxysmal supraventricular tachycardia from Vietnam. A prospective study was conducted from January 2009 to July 2016 at the University Medical Center, Ho Chi Minh City, Vietnam. Ninety-five children diagnosed with paroxysmal supraventricular tachycardia were enrolled; 90 patients underwent cardiac electrophysiology and RFCA. The patients were followed up for 3-12 months, with a mean follow-up period of 7.5 ± 2.3 months. The average age of the patients was 10.5 ± 3 years, with the youngest patient being 4 years old; 46.3% of the patients were female and 53.7% were male. The patients' average weight was 35.2 ± 9.6 kg. Atrioventricular reentrant tachycardia accounted for 72.6% of the cases and atrioventricular nodal reentrant tachycardia for 27.4% of the cases; no patients had atrial tachycardia. The success rate of RFCA was 98.9% (89/90 patients). During the 12-month follow-up, 5.6% of the patients experienced recurrence but were successfully treated with a second ablation. No severe complications were reported during the procedure and follow-up. This study found RFCA to be a safe and effective treatment for paroxysmal supraventricular tachycardia in children. It demonstrated a high success rate and low recurrence and complication rates for RFCA in children, thereby highlighting the potential advantages of the procedure as a treatment option.
Topics: Adult; Humans; Male; Child; Female; Adolescent; Child, Preschool; Prospective Studies; Tachycardia, Supraventricular; Treatment Outcome; Tachycardia, Ventricular; Tachycardia, Atrioventricular Nodal Reentry; Catheter Ablation
PubMed: 37786440
DOI: 10.7150/ijms.86594 -
Anatolian Journal of Cardiology Nov 2019Supraventricular arrhythmias are frequent, and symptomatic patients often need medical therapy or catheter ablation. The recently published 2019 European Society of... (Review)
Review
Supraventricular arrhythmias are frequent, and symptomatic patients often need medical therapy or catheter ablation. The recently published 2019 European Society of Cardiology (ESC) Guidelines for the management of patients with supraventricular tachycardia (SVT) give a comprehensive overview of current developments in the field and provides recommendations for the management of adults with SVT. In this paper, we briefly summarized major new recommendations and significant changes from the former ESC guideline published 16 years ago.
Topics: Cardiology; Consensus Development Conferences as Topic; Europe; Humans; Practice Guidelines as Topic; Societies, Medical; Tachycardia, Supraventricular
PubMed: 31789617
DOI: 10.14744/AnatolJCardiol.2019.93507 -
PloS One 2021Patients with pulmonary hypertension (PH) frequently suffer from supraventricular tachycardias (SVT). The main purpose of our study was to identify the cumulative...
PURPOSE
Patients with pulmonary hypertension (PH) frequently suffer from supraventricular tachycardias (SVT). The main purpose of our study was to identify the cumulative incidence of SVT in patients with different etiologies of PH. The secondary objective was to analyse the clinical impact of SVT.
METHODS
We retrospectively studied the prevalence of SVT and the clinical outcome in 755 patients (41% males; 60 ± 15 years; mean follow-up 3.8 ± 2.8 years) with PH of different etiologies. The prevalence of SVT was analysed separately in isolated pre-capillary PH (Ipc-PH) and in patients with combined post- and pre-capillary PH (Cpc-PH).
RESULTS
The prevalence of SVT in the Ipc-PH group (n = 641) was 25% (n = 162). The most prevalent arrhythmias were atrial fibrillation followed by a typical atrial flutter (17% and 4.4% of all Icp-PH patients). An excessive prevalence of SVT was found in patients with pulmonary arterial hypertension associated with congenital heart disease (35%, p = 0.01). Out of the overall study population, Cpc-PH was present in 114 (15%) patients. Patients with Cpc-PH manifested a higher prevalence of SVT than subjects with Ipc-PH (58; 51% vs. 162; 25%; p <0.0001) and were more likely to have persistent or permanent atrial fibrillation (38; 29% vs. 61; 10%; p <0.0001). Parameters significantly associated with mortality in a multivariate analysis included age, male gender, functional exercise capacity and right atrial diameter (p < 0.05). Neither diagnosis of SVT nor type of arrhythmia predicted mortality.
CONCLUSIONS
The study detected a significant prevalence of SVT in the population of PH of different origins. Different spectrum and prevalence of arrhythmia might be expected in different etiologies of PH. Patients with an elevated post-capillary pressure showed a higher arrhythmia prevalence, predominantly due to an excessive number of atrial fibrillations. The diagnosis of SVT was not associated with mortality.
Topics: Aged; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Prevalence; Tachycardia, Supraventricular; Treatment Outcome
PubMed: 33471824
DOI: 10.1371/journal.pone.0245752 -
Revista Portuguesa de Cardiologia :... Mar 2014Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important... (Review)
Review
Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation. Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias. The authors' objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia.
Topics: Diagnosis, Differential; Electrocardiography; Humans; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 24656320
DOI: 10.1016/j.repc.2013.07.016 -
Revue Medicale de Liege May 2004The purpose of this retrospective study was to investigate the clinical characteristics in pediatric patients with supraventricular or ventricular tachycardia.... (Review)
Review
The purpose of this retrospective study was to investigate the clinical characteristics in pediatric patients with supraventricular or ventricular tachycardia. Sixty-nine pediatric patients were included. Age distribution at first episode of tachyarrythmia, most indicative symptoms and signs, associated conditions and long-term prognosis were determined for the different mechanisms of tachyarrythmia. 78% of the children had supraventricular tachycardia and 22% ventricular tachycardia. At diagnosis, 57% of the children with supraventricular tachycardia were younger than 1 year. The majority of infants were detected during routine investigation without having any complaints whereas the majority of children presented with symptoms. Recurrence was rare in cases diagnosed during infancy, but was usual in cases diagnosed beyond infancy.
Topics: Age of Onset; Child; Child, Preschool; Female; Humans; Infant; Infant, Newborn; Male; Prognosis; Recurrence; Retrospective Studies; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 15264583
DOI: No ID Found -
Circulation Journal : Official Journal... Sep 2009The role of radiofrequency catheter ablation (RFCA) of supraventricular tachycardia (SVT) in infants and toddlers is still unclear.
BACKGROUND
The role of radiofrequency catheter ablation (RFCA) of supraventricular tachycardia (SVT) in infants and toddlers is still unclear.
METHODS AND RESULTS
From 1993 to 2006, 27 (17 males, 10 females) of 210 patients underwent RFCA at an age less than 6 years. Indications included drug-refractory SVT or tachycardia-induced cardiomyopathy. The medical records were reviewed and the patients were interviewed regarding their current status. The 27 patients underwent RFCA at a median age of 4.4 years (8 months to 5.9 years) and a median body weight of 15 kg (6.6-30 kg). The SVT was mainly atrioventricular reentry tachycardia (15/27) and multiple mechanisms in 3. One-third of them had associated congenital heart disease, and 5 underwent RFCA using only 2-3 catheters. Immediate success rate was 92.6%, with low early (3.7%) and late recurrence (7.4%) after 5.4 +/-3.7 years follow-up. Tachycardia-induced cardiomyopathy was noted in 4 and resolved in all after RFCA. Procedure-related complications included complete atrioventricular block in 1 and Bezold-Jarisch reflex in another. No other risk factors for outcomes were noted, even with low body weight.
CONCLUSIONS
The outcome of RFCA for medically refractory SVT, even associated with tachycardia-induced cardiomyopathy, in infants and toddlers is favorable.
Topics: Anti-Arrhythmia Agents; Atrioventricular Block; Body Weight; Cardiomyopathies; Catheter Ablation; Child; Child, Preschool; Drug Resistance; Electrophysiologic Techniques, Cardiac; Female; Humans; Infant; Male; Recurrence; Reflex; Risk Assessment; Tachycardia, Atrioventricular Nodal Reentry; Tachycardia, Supraventricular; Time Factors; Treatment Outcome
PubMed: 19609044
DOI: 10.1253/circj.cj-09-0123 -
Annals of Noninvasive Electrocardiology... Sep 2017Differentiation of a wide complex arrhythmia can pose as a clinical challenge in the acute care setting. Two broad differentials exist including ventricular tachycardia...
Differentiation of a wide complex arrhythmia can pose as a clinical challenge in the acute care setting. Two broad differentials exist including ventricular tachycardia versus supraventricular tachycardia with aberrancy, underlying bundle branch block or intrinsic conduction defect. To aid in distinguishing between supraventricular tachycardia and ventricular tachycardia, Brugada criteria is commonly used, albeit new algorithms have become more common. Marriott's sign, a taller peak in the first R wave when compared to R' is considered a specific criterion for distinguishing between these two entities and strongly favors the diagnosis of ventricular tachycardia. In this case we present a wide complex tachycardia, which is an exception to Marriott's sign.
Topics: Diagnosis, Differential; Electrocardiography; Humans; Male; Middle Aged; Tachycardia, Supraventricular; Tachycardia, Ventricular
PubMed: 28467014
DOI: 10.1111/anec.12449 -
Journal of Cardiovascular... Jul 2021
Topics: Heart Atria; Humans; Tachycardia, Supraventricular
PubMed: 33955113
DOI: 10.1111/jce.15073 -
BMC Cardiovascular Disorders Jul 2020Loss-of-function mutations of human cardiac sodium channel gene SCN5A induce a wide range of arrhythmic disorders. Mutation carriers with co-existing conditions such as...
Postoperative supraventricular tachycardia and polymorphic ventricular tachycardia due to a novel SCN5A variant: a case report of a rare comorbidity that is difficult to diagnose.
BACKGROUND
Loss-of-function mutations of human cardiac sodium channel gene SCN5A induce a wide range of arrhythmic disorders. Mutation carriers with co-existing conditions such as congenital heart diseases and histories of cardiac surgeries, could develop complex arrhythmic events that are difficult to diagnose.
CASE PRESENTATION
A 41-year-old Japanese male with a history of a surgical closure of an ASD presented impairment of consciousness by wide QRS tachycardia. Because the patient's baseline ECG in sinus rhythm showed similar QRS axis with right bundle brunch block morphology, we suspected supraventricular tachycardia (SVT). During hospitalization, the patient developed polymorphic ventricular tachycardia that was induced by bradycardia. In an electrophysiological study, the SVT was identified as right atrial incisional tachycardia circulating around the scar in the right atrium. The genetic analysis revealed a heterozygous SCN5A c.4037-4038 del TC, p. L1346HfsX38 variant. We diagnosed this patient as having progressive cardiac conduction disorder (PCCD) and polymorphic VT caused by the mutation. Incisional tachycardia with wide QRS morphology was a by-standing comorbidity related to the history of cardiac surgery which could miss lead the diagnosis. The patient's SVT was eliminated by radiofrequency catheter ablation. An implantable cardioverter defibrillator (ICD) was implanted for the secondary prevention of polymorphic VT. Cardiac pace-making therapy by the ICD to avoid bradycardia effectively suppressed the patient's arrhythmic events.
CONCLUSIONS
We treated a patient with a sodium channel gene variant. Co-existing SVT originated by a scar in the right atrium made the diagnosis extremely difficult. A multilateral diagnostic approach using an ECG analysis, an electrophysiological study, and genetic screening enabled effective combination therapy comprised of catheter ablation and an ICD.
Topics: Adult; Cardiac Surgical Procedures; Catheter Ablation; Defibrillators, Implantable; Electric Countershock; Genetic Predisposition to Disease; Heart Rate; Heart Septal Defects, Atrial; Humans; Loss of Function Mutation; Male; NAV1.5 Voltage-Gated Sodium Channel; Risk Factors; Tachycardia, Supraventricular; Tachycardia, Ventricular; Treatment Outcome
PubMed: 32615940
DOI: 10.1186/s12872-020-01601-2