Mori Masayoshi, Ichikawa Chihiro, Matsuyama Taka-Aki, Nawa-Hasegawa Risa, Aoki Hisaaki
Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
Department of Pathology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka 594-1101, Japan.
Eur Heart J Case Rep. 2024 Sep 10;8(9):ytae493. doi: 10.1093/ehjcr/ytae493. eCollection 2024 Sep.
An atrioventricular node (AVN) ablation and permanent pacing have been previously reported as effective treatments for patients with atrial tachyarrhythmias. However single-ventricle patients requiring chronic ventricular pacing are at a higher risk of developing ventricular dysfunction and atrioventricular valve regurgitation. We report a case of successful AVN ablation in a 3-month-old infant with hypoplastic left heart syndrome and ectopic atrial tachycardia (EAT).
A boy with hypoplastic left heart syndrome who had a refractory EAT resistant to various medications. At 2 months old, we performed an urgent radiofrequency (RF) catheter ablation of the EAT and the applications delivered at the cavo-atrial junction. Although it disappeared after the first catheter ablation for 2 weeks, it recurred on the next day after the diaphragm plication. At 3 months old and weighed 3.1 kg, we decided to perform an urgent AVN ablation of the EAT. The application was performed on the mid-septum of the tricuspid septum. A permanent pacemaker was implanted after the ablation. After the AVN ablation, the haemodynamics stabilized during the EAT. However, he died from a bacteraemia infection at 4 months.
This patient received an AVN ablation due to failure to previous RF catheter ablation and was haemodynamically stable with the dual-chamber pacemaker. The AV block was successfully created by RF energy on the mid-septum of the tricuspid annulus in this hypoplastic left heart syndrome patient. Pathological findings exhibited that the compact AVN was totally ablated without damage to the tricuspid leaflets or coronary artery.
先前已有报道称，房室结（AVN）消融术和永久性起搏是治疗房性快速心律失常患者的有效方法。然而，需要长期心室起搏的单心室患者发生心室功能障碍和房室瓣反流的风险更高。我们报告了一例在一名3个月大的左心发育不全综合征并异位房性心动过速（EAT）婴儿中成功进行AVN消融的病例。
一名患有左心发育不全综合征的男孩，患有对各种药物均耐药的难治性EAT。在2个月大时，我们对EAT进行了紧急射频（RF）导管消融，并在腔静脉-心房交界处进行了操作。尽管在首次导管消融后2周EAT消失，但在膈肌折叠术后第二天复发。在3个月大、体重3.1 kg时，我们决定对EAT进行紧急AVN消融。在三尖瓣隔叶的中隔进行了操作。消融后植入了永久性起搏器。AVN消融后，EAT发作期间血流动力学稳定。然而，他在4个月时死于菌血症感染。
该患者因先前的RF导管消融失败而接受了AVN消融，且双腔起搏器使其血流动力学稳定。在这名左心发育不全综合征患者中，通过射频能量在三尖瓣环中隔成功制造了房室传导阻滞。病理结果显示致密房室结被完全消融，三尖瓣小叶和冠状动脉未受损伤。
