Atrial arrhythmias were the most common cause for ICD shocks in a primary prevention population, while ventricular tachycardia was infrequent. The association between elevated end-diastolic pressures and the occurrence of arrhythmias demonstrates the close mechano-electrical relationship in D-TGA and may be an important predictor of arrhythmic events.
Background
Ablation of atrial tachyarrhythmia in adults with congenital heart disease (ACHD) is challenging because of complex anatomy and high scar burden. We proposed that the addition of high-density mapping with the PentaRay® (Biosense Webster, Inc) mapping catheter (EAM+P) to 3-dimensional electroanatomic mapping (EAM) allows for rapid acquisition of high-resolution maps and shorter procedure times.
Methods
In this single-center, retrospective cohort study of patients with ACHD who underwent atrial arrhythmia ablation, patients were divided those who underwent ablation with EAM and those who underwent ablation with EAM+P.
Results
Fifteen ablations were performed in 13 patients using standard EAM, and 11 ablations were performed in 10 patients using EAM+P. There was no difference in mean age or complexity of congenital heart disease. The procedure duration was 1.5 times longer in the EAM than in the EAM+P group (P = .015). The dose area product was 12 times higher in the EAM than in the EAM+P group (P = .001). A higher number of venous access sites were used for EAM cases than for EAM+P cases (P = .008). Acute success rates of ablation and recurrence rates at 1 year were similar in the 2 groups. There were no procedure-related complications in either group.
Conclusion
This is the first study to evaluate the use of the PentaRay® high-density mapping catheter for ablation of atrial tachyarrhythmia in patients with ACHD. The use of the PentaRay® high-density mapping catheter results in shorter procedure time, decreased radiation exposure, and fewer venous access sites.
Ejection fraction and BNP levels were not sensitive parameters in evaluating pediatric patients who are chronically paced. Subtle diastolic changes, especially of the right ventricle, were detected by TDI.
Cardiac resynchronization therapy is increasingly being used in the paediatric population as a tool for managing patients with heart failure. Various non-invasive parameters have been used to optimize the settings on the biventricular pacemaker. We describe implantation of a biventricular pacemaker in a nineteen-month-old child because of intractable heart failure. By analysing a 17-segment model using strain analysis of the left ventricle, we were able to place the left ventricular lead at the latest activated segment. Furthermore, we were able to minimize the dyssynchrony of the left ventricle when evaluating a range of pacemaker settings.
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