ABSTRACT
Supraventricular tachycardias (SVT) are the most frequent cause of tachycardia in children. Its pharmacological treatment has adverse effects, is not curative and is not always effective. During the last few years radiofrequency ablation (RF-A) has changed the treatment. The purpose of this study is to evaluate our experience in RF-A in children with SVT. Between 1990 and 1995, 92 patients (1 mont to 17 years old) underwent electrophysiological study after the diagnosis of SVT. RF-A was attempted in 55 patients with accessory pathways (AP), slow-pathway of the atrioventricular node, or ectopic focus. The site of ablation was decided according to the electrical signals and the catheter position. The success of the RF-A was confirmed by the interruption of the tachychardia, the change in the sequence of activation of the intracardiac signals, the regression of the preexcitation and the inability to reinduce tachycardia. RF-A was succesful in 81 percent of the patients; 88 percent in those with a left AP 56 percent in those with a right arterial obstruction, one with a minimal pneumothorax and one with cardiac tamponade. During a follow up of 16.6 months there was no relapse nor late complications. We conclude that RF-A is a safe and effective procedure in pediatric patients with SVT
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Adolescent , Tachycardia, Supraventricular/therapy , Catheter Ablation/methods , Catheter Ablation/adverse effects , Electrophysiology/methodsABSTRACT
Presentamos un caso clínico de taquicardia supraventricular fetal complicado con hidrops fetalis diagnosticado a las 27 semans de gestación por medio de ecocardiografía fetal. Se realizó tratamiento in utero con digitálicos por vía materna con remisión de la TSV y del hidrops fetalis. A las 34 semanas se obtiene un RN sano con control electrocardiográfico continuo normal
Subject(s)
Humans , Female , Pregnancy , Adult , Hydrops Fetalis , Tachycardia, Supraventricular , Ultrasonography, Prenatal/methods , Digitalis Glycosides/administration & dosage , Tachycardia, Supraventricular/drug therapyABSTRACT
We report a 29 years old male with a non obstructive hypertrophic cardiomyopathy that survived two episodies of cardiac arrest and with a familiar history of the disease and sudden death. He had an implant of an automatic implantable cardioverter defibrillator by a left anterior thoracotomy with intraoperative electrophysiology. The postoperative outcome was uneventful. After one year of follow up, the patient is in good functional capacity and the implanted device has not performed defibrillations
Subject(s)
Humans , Male , Adult , Cardiomyopathy, Hypertrophic/surgery , Defibrillators, Implantable , Death, Sudden, Cardiac/prevention & control , Echocardiography , Tachycardia, Ventricular/therapy , Amiodarone/administration & dosage , Atrial Fibrillation/therapy , Ventricular Function, Left/physiology , HemodynamicsABSTRACT
En 21 pacientes (edad promedio 9,7, márgenes 4 a 16 años) con taquicardias paroxísticas supraventriculares por haces paraespecíficos, se realizaron estudios eslectrofisiológicos y ablación de los haces por radiofrecuencia. Dos pacientes tenían malformaciones congénitas del corazón. La ablación se consiguió en 12/15 haces anómalos izquierdos (80 por ciento) y en 4/6 derechos (67 por ciento), en 10/12 pacientes con preexitación (83//) y 6/9 haces ocultos (67 por ciento) (diferencias no significativas). El buen éxito se obtuvo en 76 por ciento (16/21) del total de pacientes, pero éste aumentó a 84 por ciento (p=0,048 Fisher) después de eliminar los pacientes con malformaciones congénitas. Las complicaciones observadas incluyeron obstrución arterial con síndrome de compartimiento y perforación con taponamiento (un caso de cada una). La ablación por radiofrecuencia es un tratamiento adecuado y definitivo en niños con taquicardia paroxística supraventricular,independientemente de la localización de la vía anómala y la presencia de preexitación, pero puede fracasar en casos de malformaciones cardíacas. Las complicaciones de importancia son poco frecuentes, pero pueden llegar a ser graves, lo que exige una rigurosa selección de los pacientes a estudiar
Subject(s)
Child, Preschool , Child , Adolescent , Catheter Ablation/methods , Bundle of His/physiopathology , Tachycardia, Paroxysmal/physiopathology , Catheter Ablation/adverse effects , Electrophysiology/methods , Pre-Excitation Syndromes/physiopathology , Tachycardia, Supraventricular/diagnosis , Tachycardia, Paroxysmal/diagnosisABSTRACT
Between august 1991 and august 1993, 75 patients (42 male) with Wolff Parkinson White syndrome (43 concealed) were subjected to radiofrequency ablation of accesory pathway at our institution. 55 had left, 8 postero septal, 2 anteroseptal and 10 right accesory pathways. A retrograde aortic technique with placement of the ablation catheter in close proximity to the mitral annulus was used for most of the patients with left accesory pathways and for some with posteroseptal pathways were ablated using a right heart approach placing the ablation catheter in the tricuspid annulus. Ablation was successful in 61 patients (81 per cent ). One subject developed a fatal cardiac tamponade after a transeptal catheterization and was unrelated to the ablation per se. It is concluded that radiofrequency ablation of accesory pathways is a curative procedure for a great majority of patients with Wolf Parkinson White syndrome