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Transcatheter radiofrequency ablation using near-zero fluoroscopy in children with fascicular ventricular tachycardia: a single-centre experience

Published online by Cambridge University Press:  08 May 2020

Sevket Balli ,
Mehmet Kucuk Open the ORCID record for Mehmet Kucuk [Opens in a new window]  and
Serdar Epçaçan Open the ORCID record for Serdar Epçaçan [Opens in a new window]
Sevket Balli
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, University of Health Sciences, Istanbul, Turkey
Mehmet Kucuk*
Affiliation:
Department of Pediatric Cardiology, Samsun Training and Research Hospital, Samsun, Turkey
Serdar Epçaçan
Affiliation:
Department of Pediatric Cardiology, Van Training and Research Hospital, Van, Turkey
*
Author for correspondence: Assoc. Prof. M. Küçük, Samsun Training and Research Hospital, 100. yil bulvari Kadin Dogum ve Cocuk Hastaliklari Hizmet Binasi Ilkadim, Samsun, Turkey. Tel: +90362 2309100; Fax: +90362 3111500. E-mail: [email protected]
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Abstract

Objective:

Fascicular tachycardia is a common form of sustained idiopathic left ventricular tachycardia. This study aimed to achieve successful results with catheter ablation procedures performed through three-dimensional electroanatomic mapping using near-zero fluoroscopy in fascicular tachycardia patients.

Methods and results:

In this study, we included 33 consecutive children with fascicular tachycardia, for whom we performed a transcatheter radiofrequency ablation procedure using the EnSite® system. Activation mapping was performed in all patients during tachycardia, and the earliest presystolic purkinje potentials were the target site for radiofrequency lesions.

Results:

Twenty-five patients were male, and eight were female. The mean weight of the patients was 39.6 ± 10.4 kg, and the mean age was 13.6 ± 2.5 years. The mean procedure time was 121.3 ± 44.3 minutes. The mean follow-up period was 18.4 ± 6.5 months. No fluoroscopy was needed in 30 patients. The mean fluoroscopy time in the remaining patients was 166.6 ± 80 seconds. All of the patients had left posterior fascicular tachycardia except for one who had left anterior fascicular tachycardia. The acute success rate was perfect (100%). No patients developed left bundle branch block or complete atrioventricular block. Recurrence developed in one patient.

Conclusion:

We suggest that radiofrequency ablations via an electroanatomic mapping system are quite safe and effective, with high success rates in paediatric patients with fascicular tachycardia. This method has the advantage of avoiding ionising radiation exposure for both the patient and operator, thus reducing the lifetime risk of malignancy in the paediatric population.

Keywords

Fascicular ventricular tachycardiaelectroanatomic mappingfluoroscopyablation
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 779 - 784
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Zipes, DP, Foster, PR, Troup, PJ, Pedersen, DH. Atrial induction of ventricular tachycardia: reentry versus triggered automaticity. Am J Cardiol 2000; 44: 1–8.10.1016/0002-9149(79)90242-XCrossRefGoogle Scholar
Ohe, T, Aihara, N, Kamakura, S, Kurita, T, Shimizu, W, Shimomura, K. Long-term outcome of verapamil-sensitive sustained left ventricular tachycardia in patients without structuralheart disease. J Am Coll Cardiol 1995; 25: 54–58.10.1016/0735-1097(94)00324-JCrossRefGoogle ScholarPubMed
Tondo, C, Carbucicchio, C, Russo, AD, et al.Idiopathic ventricular tachycardia: transcatheter ablation or antiarrhythmic drugs? J Atr Fibrillation 2015; 7: 1164.Google ScholarPubMed
Alahmad, Y, Asaad, NA, Arafa, SO, Ahmad Khan, SH, Mahmoud, A. Idiopathic fascicular left ventricular tachycardia. Heart Views 2017; 18: 83–87.Google ScholarPubMed
Collins, KK, Schaffer, MS, Liberman, L, et al.Fascicular and nonfascicular left ventricular tachycardias in the young: an international multicenter study. J Cardiovasc Electrophysiol 2013; 24: 640–648.10.1111/jce.12105CrossRefGoogle Scholar
Pearce, MS, Salotti, JA, Little, MP, et al.Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380: 499–505.10.1016/S0140-6736(12)60815-0CrossRefGoogle ScholarPubMed
Creta, A, Chow, A, Sporton, S, et al.Catheter ablation for fascicular ventricular tachycardia: a systematic review. Int J Cardiol 2019; 276: 136–148.10.1016/j.ijcard.2018.10.080CrossRefGoogle ScholarPubMed
Balli, S, Kucuk, M, Orhan Bulut, M, Kemal Yucel, I, Celebi, A. Transcatheter cryoablation procedures without fluoroscopy in pediatric patients with atrioventricular nodal reentrant tachycardia: a single-center experience. Acta Cardiol Sin 2018; 34: 337–343.Google ScholarPubMed
Koca, S, Akdeniz, C, Karacan, M, Tuzcu, V. Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure. Cardiol Young 2019; 29: 793–799.10.1017/S1047951119000830CrossRefGoogle ScholarPubMed
Liu, L, Fang, Z, Yang, B, et al.Catheter ablation of fascicular ventricular tachycardia long-term clinical outcomes and mechanisms of recurrence. Circ Arrhythm Electrophysiol 2015; 8: 1443–1451.10.1161/CIRCEP.115.003080CrossRefGoogle ScholarPubMed
Tuzcu, V, Gul, EE, Erdem, A, et al.Cardiac interventions in pregnant patients without fluoroscopy. Pediatr Cardiol 2015; 36: 1304–1304.10.1007/s00246-015-1181-xCrossRefGoogle ScholarPubMed
Johnson, JN, Hornik, CP, Li, JS, et al.Cumulative radiation exposure and cancer risk estimation in children with heart disease. Circulation 2014; 30: 161–167.CrossRefGoogle Scholar
Lyan, E, Tsyganov, A, Abdrahmanov, A, et al.Nonfluoroscopic catheter ablation of paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2018; 41: 611–619.10.1111/pace.13321CrossRefGoogle ScholarPubMed
Talib, AK, Nogami, A. Anatomical ablation strategy for noninducible fascicular tachycardia. Card Electrophysiol Clin 2016; 8: 115–120.10.1016/j.ccep.2015.10.012CrossRefGoogle ScholarPubMed
Park, J, Kim, YH, Hwang, C, Pak, HN. Electroanatomical characteristics of idiopathic left ventricular tachycardia and optimal ablation target during sinus rhythm: significance of preferential conduction through Purkinje fibers. Yonsei Med J 2012; 53: 279–288.10.3349/ymj.2012.53.2.279CrossRefGoogle ScholarPubMed
Luo, B, Zhou, G, Guo, X, et al.Long-term outcome of catheter ablation for left posterior fascicular ventricular tachycardia with the development of left posterior fascicular block and characteristics of repeat procedures. Int J Cardiol 2017; 236: 203–203.10.1016/j.ijcard.2017.01.152CrossRefGoogle ScholarPubMed
Nishiuchi, S, Nogami, A, Naito, S. A case with occurrence of antidromic tachycardia after ablation of idiopathic left fascicular tachycardia: mechanism of left upper septal ventricular tachycardia. J Cardiovasc Electrophysiol 2013; 24: 825–827.10.1111/jce.12072CrossRefGoogle ScholarPubMed
Nair, GM, Thomas, V, Stoyanov, N, Nery, PB, Sadek, MM, Green, MS. Upper septal transformation of verapamil-sensitive idiopathic left ventricular tachycardia during catheter ablation: wolf in sheep’s clothing? HeartRhythm Case Rep 2015; 2: 101–106.10.1016/j.hrcr.2015.11.011CrossRefGoogle Scholar
Gopi, A, Nair, SG, Shelke, A, et al.A stepwise approach to the induction of idiopathic fascicular ventricular tachycardia. J Interv Card Electrophysiol 2015; 44: 17–22.10.1007/s10840-015-0022-4CrossRefGoogle ScholarPubMed
Belardinelli, L, Fenton, RA, West, A, Linden, J, Althaus, JS, Berne, RM. Extracellular action of adenosine and the antagonism by aminophylline on the atrioventricular conduction of isolated perfused guinea pig and rat hearts. Circ Res 1982; 51: 569–579.CrossRefGoogle ScholarPubMed
Lerman, BB. Response of nonreentrant catecholamine-mediated ventricular tachycardia to endogenous adenosine and acetylcholine. Evidence for myocardial receptor-mediated effects. Circulation 1993;87: 382–390.10.1161/01.CIR.87.2.382CrossRefGoogle ScholarPubMed
Aliot, EM, Stevenson, WG, Almendral-Garrote, JM, Bogun, F, Calkins, CH, Delacretaz, E, et alEHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Heart Rhythm 2009; 6: 886–933.10.1016/j.hrthm.2009.04.030CrossRefGoogle Scholar