Radiofrequency catheter ablation in a haemodynamically compromised premature neonate with hydrops fetalis

Location and variability of epicardiac ganglia in human fetuses

The aim of the study was to determine the morphology of epicardiac ganglia in human fetuses at different stages of their development as these ganglia are considered to be of a pivotal clinical importance. Twenty-one fetal hearts were investigated applying a technique of histochemistry for acetylcholinesterase to visualize the epicardiac neural ganglionated plexus with its subsequent stereoscopic examination on total organs. In all of the examined fetuses, epicardiac neural plexus with numerous ganglia was well recognizable and could be clearly differentiated into seven ganglionated subplexuses, topography and structural organization of which were typical for hearts of adult human. The largest ganglion number comprising 77% of all counted ganglia was identified on the dorsal atrial surface. Fetal epicardiac plexus in gestation period of 15-40 weeks contained 929 +/- 62 ganglia, but ganglion amount did vary substantially from heart to heart. In conclusion, this study implies that the human fetal epicardiac ganglia occupy their definitive location already at gestation period from 15 weeks and their number as well as distribution on heart surface presumably is not age dependent.

Low-energy radiofrequency catheter ablation as therapy for supraventricular tachycardia in a premature neonate

A premature neonate with hydrops was born at 32 weeks of gestation after successful direct fetal amiodarone therapy via cordocentesis for incessant supraventricular tachycardia. After birth the tachycardia could not be controlled despite high doses of amiodarone and flecainide and the patient developed severe respiratory and circulatory failure. After 3 weeks, weighing 2 kg, he underwent successful and uncomplicated catheter ablation of a left free-wall accessory pathway using low-energy radiofrequency.

CONCLUSION

radiofrequency catheter ablation is rarely used in neonates, but when used with caution may provide the optimal treatment.

Neonatal tachyarrhythmias

CARDIAC ARRHYTHMIAS CAN BE found in the fetus and the neonate. Arrhythmias that are seen in the neonate include sinus bradycardia and tachycardia, premature atrial and ventricular contractions, supraventricular tachycardia, atrial flutter, ventricular arrhythmias, and heart block. Although infants with structural or functional anomalies can have arrhythmias, many arrhythmias result from noncardiac causes, such as hypoxemia and acidosis.1