Paja Steliana Cosmina, Gondoș Viviana, Deaconu Silvia, Cinteză Eliza, Vătășescu Radu
Cardiology Department, Clinic Emergency Hospital, Bucharest, Romania.
Department of Medical Electronics and Informatics, Polytechnic University of Bucharest, Bucharest, Romania.
Front Pediatr. 2024 Feb 16;12:1358505. doi: 10.3389/fped.2024.1358505. eCollection 2024.
Supraventricular arrhythmias have become an increasingly significant contributor to the risk of mortality and morbidity in adults with complex congenital heart disease (CHD), especially in light of recent advances in palliative corrective surgeries. Because of their unique characteristics, they demand specific treatment approaches. While pharmaco-logical interventions are an option, they have limited effectiveness and may lead to side effects. Although performing radiofrequency ablation (RFA) can be exceptionally challenging in patients with complex CHD, due to particular vascular access and also modified anatomy, it has paved the way to enhance comprehension of the underlying mechanisms of supraventricular arrhythmias. This, in turn, enables the provision of improved therapies and, ultimately, an enhancement in the quality of life and symptom management for these patients. The purpose of this case report is to highlight the benefits of utilizing advanced technologies such as three-dimensional electro-anatomical mapping systems, remote magnetic navigation, and highly flexible mapping and ablation catheters during RFA in a young adult with complex congenital heart disease. Although he lacked venous connections to the right atrium (RA) due to multiple corrective surgeries we, remarkably, were capable to advance a decapolar deflectable diagnostic catheter inside the Fontan tunnel and from there to record and stimulate the RA. Successful ablation of two accessory pathways was achieved with no arrhythmia recurrence during follow-up.
室上性心律失常已成为导致复杂先天性心脏病（CHD）成人患者死亡和发病风险的一个日益重要的因素，特别是鉴于近期姑息性矫正手术的进展。由于其独特的特征，需要采用特定的治疗方法。虽然药物干预是一种选择，但效果有限且可能导致副作用。尽管对复杂CHD患者进行射频消融（RFA）极具挑战性，原因在于特殊的血管通路以及解剖结构的改变，但它为深入理解室上性心律失常的潜在机制铺平了道路。这反过来又能够提供更好的治疗方法，并最终提高这些患者的生活质量和症状管理水平。本病例报告的目的是强调在一名患有复杂先天性心脏病的年轻成人进行RFA期间，使用三维电解剖标测系统、远程磁导航以及高度灵活的标测和消融导管等先进技术的益处。尽管由于多次矫正手术，他缺乏与右心房（RA）的静脉连接，但我们非常成功地将一根十极可弯曲诊断导管推进到Fontan通道内，并从那里记录和刺激RA。成功消融了两条旁路，随访期间无心律失常复发。
