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Catheter ablation of left posterior fascicular ventricular tachycardia in children with limited fluoroscopy exposure

Published online by Cambridge University Press:  06 June 2019

Serhat Koca ,
Celal Akdeniz ,
Mehmet Karacan  and
Volkan Tuzcu
Serhat Koca*
Affiliation:
Pediatric and Genetic Arrhythmia Center, Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
Celal Akdeniz
Affiliation:
Pediatric and Genetic Arrhythmia Center, Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
Mehmet Karacan
Affiliation:
Pediatric and Genetic Arrhythmia Center, Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
Volkan Tuzcu
Affiliation:
Pediatric and Genetic Arrhythmia Center, Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
*
Author for correspondence: Serhat Koca, MD, Kizilay St. no. 4 Sihhiye, Ankara, Turkey. Tel: +90 506 581 8248; E-mail: [email protected]
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Abstract

Introduction:

Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group.

Methods:

A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients.

Results:

The mean patient age was 12.7 years (range 2–16), and the mean patient weight was 51 kg (range 11–84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen.

Conclusions:

Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.

Keywords

Left posterior fascicular ventricular tachycardiachildrenPurkinje potentialscatheter ablationthree-dimensional mapping
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 6 , June 2019 , pp. 793 - 799
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Copyright
© Cambridge University Press 2019 

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References

Wang, S, Zhu, W, Hamilton, RM, Kirsh, JA, Stephenson, EA, Gross, GJ. Diagnosis-specific characteristics of ventricular tachycardia in children with structurally normal hearts. Heart Rhythm 2010; 7: 1725–1731.CrossRefGoogle ScholarPubMed
Pfammatter, JP, Paul, T. Idiopathic ventricular tachycardia in infancy and childhood: a multicenter study on clinical profile and outcome. Working Group on Dysrhythmias and Electrophysiology of the Association for European Pediatric Cardiology. J Am Coll Cardiol 1999; 33: 2067–2072.CrossRefGoogle Scholar
Chu, J, Sun, Y, Zhao, Y, et al. Identification of the slow conduction zone in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia using electroanatomic mapping. J Cardiovasc Electrophysiol 2012; 23: 840–845.CrossRefGoogle Scholar
Kataria, V, Yaduvanshi, A, Kumar, M, Nair, M. Demonstration of posterior fascicle to myocardial conduction block during ablation of idiopathic left ventricular tachycardia: an electrophysiological predictor of long-term success. Heart Rhythm 2013; 10: 638–645.CrossRefGoogle ScholarPubMed
Fukuhara, J, Sumitomo, N, Nakamura, T, et al. Electrophysiological characteristics of idiopathic ventricular tachycardia in children. Circ J 2011; 75: 672–676.CrossRefGoogle 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.CrossRefGoogle Scholar
Tuzcu, V. Significant reduction of fluoroscopy in pediatric catheter ablation procedures: long-term experience from a single center. Pacing Clin Electrophysiol 2012; 35: 1067–1073.CrossRefGoogle ScholarPubMed
Akdeniz, C, Gul, EE, Celik, N, Karacan, M, Tuzcu, V. Catheter ablation of idiopathic right ventricular arrhythmias in children with limited fluoroscopy. J Interv Card Electrophysiol 2016; 3: 355–360.CrossRefGoogle Scholar
Swissa, M, Birk, E, Dagan, T, et al. Limited fluoroscopy catheter ablation of accessory pathways in children. J Cardiol 2017; 4: 382–386.CrossRefGoogle Scholar
Clark, BC, Sumihara, K, McCarter, R, Berul, CI, Moak, JP. Getting to zero: impact of electroanatomical mapping on fluoroscopy use in pediatric catheter ablation. J Interv Card Electrophysiol 2016; 2: 183–189.CrossRefGoogle Scholar
Liu, Y, Fang, Z, Yang, B, et al. Catheter ablation of fascicular ventricular tachycardia: long-term clinical outcomes and mechanisms of recurrence. Circ Arrhythm Electrophysiol 2015; 6: 1443–1451.CrossRefGoogle Scholar
Lamberti, F, Di Clemente, F, Remoli, R, et al. Catheter ablation of idiopathic ventricular tachycardia without the use of fluoroscopy. Int J Cardiol 2015; 190: 338–343.CrossRefGoogle ScholarPubMed
Kapa, S, Gaba, P, DeSimone, CV, Asirvatham, SJ. Fascicular ventricular arrhythmias: pathophysiologic mechanisms, anatomical constructs, and advances in approaches to management. Circ Arrhythm Electrophysiol 2017; 10: 1–14.CrossRefGoogle Scholar
Fishberger, SB, Olen, MM, Rollinson, NL, Rossi, AF. Creation of partial fascicular block: an approach to ablation of idiopathic left ventricular tachycardia in the pediatric population. Pacing Clin Electrophysiol 2015; 2: 209–215.CrossRefGoogle Scholar
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: 203–208.CrossRefGoogle ScholarPubMed
Horenstein, MS, Saarel, E, Dick, M II, Karpawich, PP. Reversible symptomatic dilated cardiomyopathy in older children and young adolescents due to primary non-sinus supraventricular tachyarrhythmias. Pediatr Cardiol 2003; 24: 274–279.CrossRefGoogle Scholar
Nakazato, Y. Tachycardiomyopathy. Indian Pacing Electrophysiol J 2002; 2: 104–113.Google ScholarPubMed
Grimm, W, Menz, V, Hoffman, J, Maisch, B. Reversal of tachycardia induced cardiomyopathy following ablation of repetitive monomorphic right ventricular outflow tract tachycardia. Pacing Clin Electrophysiol 2001; 24: 166–171.CrossRefGoogle ScholarPubMed
Jaggarao, NS, Nanda, AS, Daubert, JP. Ventricular tachycardia induced cardiomyopathy: improvement with radiofrequency ablation. Pacing Clin Electrophysiol 1996; 19: 505–508.CrossRefGoogle ScholarPubMed
Velázquez-Rodríguez, E, Rodríguez-Piña, H, Pacheco-Bouthillier, A, Deras-Mejía, LM. Cardiomyopathy induced by incessant fascicular ventricular tachycardia. Arch Cardiol Mex 2013; 3: 194–198.Google Scholar
Arya, A, Haghjoo, M, Davari, P, Sadr-Ameli, MA. Resolution of tachycardia-induced cardiomyopathy following ablation of verapamil sensitive idiopathic left ventricular tachycardia. Pediatr Cardiol 2006; 27: 146–148.CrossRefGoogle ScholarPubMed
Yasui, K, Shibata, T, Yokoyama, U, et al. Idiopathic sustained left ventricular tachycardia in pediatric patients. Pediatr Int 2001; 43: 42–47.CrossRefGoogle ScholarPubMed
Wangüemert Pérez, F, Hernández Afonso, JS, Groba Marco, MDV, et al. Flecainide reduces ventricular arrhythmias in patients with genotype RyR2-positive catecholaminergic polymorphic ventricular tachycardia. Rev Esp Cardiol (Engl Ed) 2018; 71: 185–191.CrossRefGoogle ScholarPubMed
Hyman, MC, Mustin, D, Supple, G, et al. Class IC antiarrhythmic drugs for suspected premature ventricular contraction-induced cardiomyopathy. Heart Rhythm 2018; 15: 159–163.CrossRefGoogle ScholarPubMed
Einstein, AJ. Medical imaging: the radiation issue. Nat Rev Cardiol 2009; 6: 436–438.CrossRefGoogle ScholarPubMed
Justino, H. The ALARA concept in pediatric cardiac catheterization: techniques and tactics for managing radiation dose. Pediatr Radiol 2006; 36: 146–153.CrossRefGoogle ScholarPubMed