Transcatheter Radiofrequency Ablation for Congenital Junctional Ectopic Tachycardia in Infancy

Abstract

Congenital junctional ectopic tachycardia (JET) is a difficult to treat arrhythmia with a variably poor response to pharmacologic intervention. We report on the successful treatment of a 17-day-old infant with JET via transcatheter radiofrequency ablation of the arrhythmogenic focus resulting in resolution of the tachycardia and maintenance of normal atrioventricular nodal function. Transcatheter radiofrequency ablation techniques should be considered in infants with life-threatening arrhythmia recalcitrant to standard forms of drug therapy.

Efficacy of a pure Ikr blockade with nifekalant in refractory neonatal congenital junctional ectopic tachycardia and careful attention to damaging the atrioventricular conduction during the radiofrequency catheter ablation in infancy

“…The successful ablation sites were the para-Hisian area and midseptal region of the tricuspid annulus, as reported in previous studies 3, 4, 6. There are several ways to resolve JET, such as applying energy at the HBE recording site where the tachycardia rate can be decreased by the mechanical manipulation of the ablation catheter 15 or by the application of energy at the earliest retrograde atrial activation site when ventriculoatrial conduction is present 16 .…”

“…There have been only 5 cases previously reported that have required CA during a patient's infancy 2, 3, 4, 6, 7. All 5 cases were successfully ablated, but the incidence of complications was high.…”

“…Although the survival rate has improved because of progress in medical treatment and catheter ablation (CA), JET is still associated with a high morbidity and mortality 2, 3, 4. There are some reports about the efficacy of medications such as amiodarone (AMD)2, 3, 4 and CA, but no reliable treatment has been established thus far. We experienced 2 cases of congenital JET, which were refractory to various antiarrhythmic agents, including AMD, but were well controlled with a nifekalant (NIF) infusion and successively underwent CA.…”

“…However, to the best of our knowledge, this is the first report on the effectiveness of an NIF infusion in infants with congenital JET. Further, there have been only 5 case reports about CA during infancy for JET 2, 3, 4, 6, 7. An accumulation of a case series is needed to improve the outcome of CA during infancy.…”

Tachycardias in Infants, Children and Adolescents: Safety and Effectiveness of Radiofrequency Catheter Ablation

“…Despite these risks, radiofrequency ablation has been successfully performed in children [12], infants [13]and even neonates [14]. …”