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Ciriello GD, Sorice D, Orlando A, Papaccioli G, Colonna D, Correra A, Romeo E, Esposito R, De Marco M, Diana V, Giordano M, Barrile LS, Russo MG, Sarubbi B. Antiarrhythmic therapy for narrow QRS supraventricular tachyarrhythmias in newborns and infants in the first year of life: Potent tools to be handled with care. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00109-8. [PMID: 39033975 DOI: 10.1016/j.ipej.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/02/2024] [Accepted: 07/19/2024] [Indexed: 07/23/2024] Open
Abstract
Supraventricular tachyarrhythmias pose a significant challenge in neonates and infants, particularly within the first year of life, where prompt and effective management is crucial. By synthesizing available evidence and clinical experience, this review aims to provide a comprehensive overview of antiarrhythmic therapy in this vulnerable population, with a focus on narrow QRS supraventricular tachyarrhythmias. This review examines the current understanding of supraventricular tachyarrhythmia management and discusses the challenges associated with antiarrhythmic therapy in newborns and infants during the critical first year of life, evaluating the efficacy and safety of various antiarrhythmic agents commonly utilized in this population, including dosing considerations, adverse effects, and strategies for acute management and prophylactic long-term antiarrhythmic treatment.
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Affiliation(s)
- Giovanni Domenico Ciriello
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy.
| | - Davide Sorice
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Antonio Orlando
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Giovanni Papaccioli
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Raffaella Esposito
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | - Marina De Marco
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | - Veronica Diana
- Appropriateness of Care Unit, Monaldi Hospital, Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | | | - Maria Giovanna Russo
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
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Melo SLD, Carvalho JND, Monge NMS, Sousa IBDS, Pisani CF, Scanavacca M. Catheter Ablation in Neonate with Heart Failure Due to Incessant Atrioventricular Reentrant Tachycardia. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Drago F, Tamborrino PP, Cazzoli I. Ablation in Pediatric Patients and in Association with Congenital Heart Disease. Card Electrophysiol Clin 2020; 12:583-590. [PMID: 33162005 DOI: 10.1016/j.ccep.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Transcatheter ablation (TA) for treatment of pediatric tachyarrhythmias was first introduced in the early 1990s. Since then, its use as an alternative to antiarrhythmic drugs to treat supraventricular tachycardias caused by accessory pathway has been increasing. Nowadays, TA can be performed with high success rates and low complication rates even in very young children. Recently, the use of different types of energy (radiofrequency and cryoenergy), special ablation catheters, and 3D nonfluoroscopic mapping systems equipped with high technological tools has further improved safety and efficacy of TA, especially in difficult substrates and in patients with congenital heart disease.
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Affiliation(s)
- Fabrizio Drago
- Cardiology and Electrophysiology/Syncope Unit, Cardiology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Pietro Paolo Tamborrino
- Cardiology and Electrophysiology/Syncope Unit, Cardiology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ilaria Cazzoli
- Cardiology and Electrophysiology/Syncope Unit, Cardiology Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Late effects of radiofrequency ablation lesions resulting in a progressive mitral valve perforation in a 2-month-old infant. Cardiol Young 2019; 29:1297-1299. [PMID: 31475639 DOI: 10.1017/s1047951119001926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There has been great concern with the use of radiofrequency ablation in infants since radiofrequency ablation lesions were shown to have a progressing nature in immature myocardium of animals. In this report, we present a 2-month-old infant with life-threatening medically refractory supraventricular tachycardia. Radiofrequency ablation successfully cured arrhythmia; however, late effects of radiofrequency ablation lesions resulted in a progressive mitral valve perforation requiring surgical repair.
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Tunca Sahin G, Ozturk E, Kasar T, Guzeltas A, Ergul Y. Sustained tachyarrhythmia in children younger than 1 year of age: Six year single-center experience. Pediatr Int 2018; 60:115-121. [PMID: 29068108 DOI: 10.1111/ped.13445] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/13/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the results of non-operational sustained tachyarrhythmia in patients <1 year of age at the present center. METHODS Between November 2010 and November 2016, the demographic characteristics, type and localization of the tachyarrhythmia, echocardiographic findings, and medical and/or ablation therapy for patients <1 year of age with sustained tachyarrhythmia were evaluated. RESULTS Of 99 patients, 91 had sustained supraventricular tachycardia, and eight had sustained ventricular tachycardia. The median age was 30 days (range, 1-350 days), and the median weight was 4.2 kg (range, 2-13 kg). The common symptoms were palpitation and restlessness (n = 49, 49.5%), or the tachycardia was detected during routine inspection (n = 25, 25.3%) or fetal echocardiography (n = 11, 11.1%). Nineteen individuals (19%) had left ventricular (LV) dysfunction on first echocardiography. Twenty individuals had congenital heart disease. Common diagnoses were Wolff-Parkinson-White syndrome (n = 27), focal atrial tachycardia (n = 10), permanent junctional reciprocating tachycardia(n = 6), and atrial flutter (n = 6). Seventeen patients underwent medical therapy combined with cardioversion. The most commonly used abortive and acute therapy agents were adenosine, esmolol, and amiodarone. The most common combination therapy was propranolol and amiodarone, followed by a propranolol and propafenone combination. Nine individuals were treated with catheter ablation due to either resistance to medical therapy or LV dysfunction. CONCLUSIONS Tachyarrhythmias in children <1 year of age are mostly caused by accessory pathways and require multidrug therapy. Catheter ablation is an effective alternative therapy in the case of resistance to medical therapy and/or LV dysfunction.
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Affiliation(s)
- Gulhan Tunca Sahin
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey
| | - Erkut Ozturk
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey
| | - Taner Kasar
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey
| | - Alper Guzeltas
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey
| | - Yakup Ergul
- Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey
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Safety and Efficacy of Radiofrequency Catheter Ablation for Tachyarrhythmia in Children Weighing Less Than 10 kg. Pediatr Cardiol 2018; 39:384-389. [PMID: 29119214 PMCID: PMC5797753 DOI: 10.1007/s00246-017-1766-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/28/2017] [Indexed: 11/28/2022]
Abstract
An increasing number of children are undergoing radiofrequency catheter ablation (RFCA) for tachyarrhythmia. However, infants and toddlers undergoing RFCA are often resistant to medication or need to eliminate arrhythmia substrate, and the risks of RFCA complications are still high in infants and toddlers. From April 2008 and December 2016, 285 children who underwent radiofrequency catheter ablation (RFCA) were stratified according to body weight (group A, less than 10 kg, n = 22; group B, over 10 kg, n = 263) and the clinical features of RFCA were retrospectively reviewed in these groups. Indications for RFCA included drug-refractory tachyarrhythmia or symptomatic tachycardia and tachycardia-induced cardiomyopathy. The acute success rate in this group was 90.9%, with a relatively low recurrence rate (15.0%) after 7.0 ± 1.6 years follow-up. We performed RFCA using only 2-4 catheters in all cases. Major complications included complete right bundle branch block in one patient. No significant differences in rates of success, recurrence, or complications were noted between children weighing less and more than 10 kg. RFCA is safe and efficacious for tachyarrhythmia even in patients weighing less than 10 kg.
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Ibarra-Castillo R, Arbaiza-Simon J, Viteri-Vela M. [Minimally fluoroscopic ablation of an accessory pathway in a child with Ebstein's anomaly: A case report]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:232-233. [PMID: 29249651 DOI: 10.1016/j.acmx.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Rita Ibarra-Castillo
- Unidad de Electrofisiología, Servicio de Cardiología, Hospital Vozandes, Quito, Ecuador.
| | - Jorge Arbaiza-Simon
- Unidad de Electrofisiología, Servicio de Cardiología, Hospital Vozandes, Quito, Ecuador
| | - Mario Viteri-Vela
- Unidad de Electrofisiología, Servicio de Cardiología, Hospital de los Valles, Quito, Ecuador
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Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, Cannon B, Clark J, Dick M, Freter A, Kertesz NJ, Kirsh JA, Kugler J, LaPage M, McGowan FX, Miyake CY, Nathan A, Papagiannis J, Paul T, Pflaumer A, Skanes AC, Stevenson WG, Von Bergen N, Zimmerman F. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 2016; 13:e251-89. [DOI: 10.1016/j.hrthm.2016.02.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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Backhoff D, Klehs S, Müller MJ, Schneider H, Kriebel T, Paul T, Krause U. Radiofrequency Catheter Ablation of Accessory Atrioventricular Pathways in Infants and Toddlers ≤ 15 kg. Pediatr Cardiol 2016; 37:892-8. [PMID: 26961570 DOI: 10.1007/s00246-016-1365-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/19/2016] [Indexed: 11/28/2022]
Abstract
Accessory atrioventricular pathways (AP) are the most common substrate for paroxysmal supraventricular tachycardia in infants and small children. Up-to-date data on AP ablation in infants and small children are limited. The aim of the present study was to gain additional insight into radiofrequency (RF) catheter ablation of AP in infants and toddlers focusing on efficacy and safety in patients with a body weight of ≤ 15 kg. Since 10/2002, RF ablation of AP was performed in 281 children in our institution. Indications, procedural data as well as success and complication rates in children with a body weight ≤ 15 kg (n = 22) were compared with children > 15 kg (n = 259). Prevalence of structural heart anomalies was significantly higher among children ≤ 15 kg (27 vs. 5.7 %; p = 0.001). Procedure duration (median 262 vs. 177 min; p = 0.001) and fluoroscopy time (median 20.6 vs. 14.0 min; p = 0.007) were significantly longer among patients ≤ 15 kg. Procedural success rate did not differ significantly between the two groups (82 vs. 90 %). More RF lesions were required for AP ablation in the smaller patients (median 12 vs. 7; p = 0.019). Major complication rate was significantly higher in children ≤ 15 kg (9 vs. 1.1 %; p = 0.05) with femoral vessel occlusion being the only major adverse event in patients ≤ 15 kg. Catheter ablation of AP in children was effective irrespective of body weight. In children ≤ 15 kg, however, procedures were more challenging and time-consuming. Complication rate and number of RF lesions in smaller children were higher when compared to older children.
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Affiliation(s)
- David Backhoff
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Sophia Klehs
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Heike Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Thomas Kriebel
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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Grant EK, Berul CI. Transcatheter therapies for arrhythmias in patients with complex congenital heart disease. Interv Cardiol 2015. [DOI: 10.2217/ica.15.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Since the introduction of transcatheter ablation in the late 1980s, there has been significant technical development. With a very high success rate and low complication rate, ablation has now become the standard of care in children and adults. However, long-term data remain insufficient and the application of ablation therapy in small children is debatable. In this review, current treatment strategies and results in toddlers and infants will be discussed. There has been improvement in success rate and complication rate for ablation in small children. Technological advancements in non-fluoroscopic electroanatomical mapping systems (3D systems) have led to the reduction of radiation and have facilitated ablations in complex cases. However, long-term effects of ablation lesions in small children remain a potential concern.
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Affiliation(s)
- Hiroko Asakai
- Labatt Family Heart Centre and Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
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