J Interv
Card Electrophysiol
DOI
10.1007/s10840-009-9456-x
Received: 1 June 2009 /
Accepted: 25 October 2009
© Springer Science +
Business Media, LLC 2010
Successful Transcatheter cryoablation in infants with
drug-resistant supraventricular tachycardia: a case series
Authors
Majd Makhoul, Nicholas H Von
Bergen, Firas Rabi, Jean Gingerich, William N Evans, Ian H Law
Source
ChildrenŐs Heart Center
Nevada, 3006 S Maryland Pkwy, Ste 690, Las Vegas, NV 89109, USA.
Abstract
Purpose
Drug-resistant supraventricular tachycardia can cause
hemodynamic instability, especially in infants. There are no case-series
reports of Transcatheter cryoablation treatment for infants with drug-resistant
supraventricular tachycardia. Our purpose is to report our experience with
Transcatheter cryoablation in three infants with drug-resistant supraventricular
tachycardia.
Methods We
reviewed clinical and electrophysiologic data from infants who underwent cryothermal
ablation for drug-resistant supraventricular tachycardia (SVT) at our
institution.
Results Three
patients (age 10–42 days) underwent Transcatheter cryothermal ablation
over a 1-year period. None had arrhythmia suppression on medical management,
and all had hemodynamic instability from persistent SVT episodes. Cryothermal
mapping (−30 C) localized the suspected foci. All foci were adjacent to
the AV node. Cryoablation lesions were delivered at and around mapped foci. In
one patient, cryothermal energy application eliminated the SVT but resulted in
transient right bundle branchblock that resolved later. Two patients had
hemodynamically insignificant episodes of SVT in the immediate post ablation period
that resolved with standard antiarrhythmic treatment. One died of sepsis but
remained SVT free for10 days after the procedure without antiarrhythmic
medications. Neither of the two surviving patients had SVT recurrence at
6-month follow-up off medications.
Conclusions In our
series, Transcatheter cryoablation was an effective treatment for
drug-resistant SVT in infants. We encountered some early nonsustained
post-procedure SVT; however, such episodes did not predict procedural failure.