Fetal Persistent junctional reciprocating tachycardia : a diagnostic and a therapeutic challenge

A mother presented with a fetus at 22±1 weeks of gestation with a sustained supraventricular tachycardia  (SVT) at initially 186 beat per minute (bpm). The fetal M-mode echocardiography showed a 1/1 atrio ventricular ratio (with short atrioventricular (AV) interval and a long ventriculo-atrial (VA) interval, suggesting a Persistent junctional reciprocating tachycardia (PJRT) . Upon  initial present no signs of heart failure or hydrops  were noted and treament was initiated with amiodarone and  digoxin . Fetus heart rate slowed  .Postnatal electrocardiogram  Confirmed  the diagnosis of PJRT New born was put on amiodarone and proparonal). Sinus rhythm was rapidly achieved 9 days later .The patient doing well at  10 months of age with maintain of sinus rhythm. Conclusion: our case report illustrates  a particular  form of  JRT   diagnosed  prenatal PJRT  , characterized  by  a good clinical tolerance, its absence of evolution towards cardiomyopathy  and its rapid and unusual response to antiarrhythmics.

Case report: an infant with congenital junctional ectopic tachycardia requiring extracorporeal mechanical oxygenation

PURPOSE OF REVIEW

A case report of an infant with hemodynamic compromise and impending collapse due to congenital junctional ectopic tachycardia. Medical therapy was maximized and he required the rapid initiation of extracorporeal life support, in order to achieve hemodynamic stability.

RECENT FINDINGS

This case report briefly reviews the presentation and treatment options for congenital junctional ectopic tachycardia, as well as the indications for initiation of mechanical support for this potentially lethal condition.

SUMMARY

Congenital junctional ectopic tachycardia is a rare though often fatal arrhythmia of the newborn or infant. Medical treatment options may be limited, or may require time to attain efficacy. Despite aggressive escalation of antiarrhythmic therapy, mechanical support in the form of extracorporeal mechanical oxygenation is a viable option, until the arrhythmia is well controlled and the myocardium recovers function.

Cryoablation of Congenital Familial Ectopic Tachycardia with Preservation of Atrioventircular Nodal Function in an Infant

A 1-year-old child weighing 8 kg with familial congenital junctional ectopic tachycardia that was difficult to treat with antiarrhythmic medications underwent successful cryoablation with preservation of atrioventricular (AV) nodal function. This report describes a strategy of cryoablation in conjunction with a 3-D mapping system and the use of atrial overdrive pacing during cryothermal application to assess AV nodal function.

A Case of Congenital Junctional Ectopic Tachycardia: Prenatal Diagnosis and Successful Radiofrequency Catheter Ablation in Infancy

It is difficult to make a definitive diagnosis of congenital junctional ectopic tachycardia (JET) in utero. We report a case in which congenial JET was suspected by fetal M-mode echocardiography. Fetal M-mode tracing of the atria and ventricle clearly showed a gradual acceleration of ventricular activity at the beginning of tachycardia, the warming-up sign of ectopic tachycardia, which was followed by simultaneous contractions of atrium and ventricle. This report also describes successful emergent radiofrequency catheter ablation of congenital JET in infancy with preservation of normal AV nodal conduction for this patient.

[Ectopic junctional tachycardia of the neonate]

Congenital ectopic junctional tachycardia (EJT) is a rare arrhythmia presenting in the first 6 months of life. It is often resistant to antiarrhythmic drugs and its poor prognosis (35% mortality) explains its often complex management. The authors report two cases which illustrate its unpredictability with a potential to degenerate to serious ventricular arrhythmias. The possibility of progression to atrioventricular block, increased by antiarrhythmic therapy, may lead to implantation of a cardiac pacemaker. The poor outcome of the two babies underlines the severity of these arrhythmias.

[Congenital atrioventricular junction tachycardia. Favorable response to anti-arrhythmia agents]

The congenital junctional ectopic tachycardia, is an unusual tachyarrhythmia, with early clinic manifestation and poor antiarrhythmic drugs response with a great infant mortality reaching rates of 35%. It deserves a special attention in its timely detection as well as in its appropriate handling with different modalities of pharmacological and nonpharmacological therapy. We reported two cases in which age of presentation of tachyarrhythmia was at three months and whose particularity was the good response to antiarrhythmic drugs; verapamil and later propafenone, used for the acute stages and a combination of propafenone plus propranolol initially for the chronic stage. Due to intolerance it was necessary to change the treatment after a year for sotalol and digital with good response. We review the literature about this topic.

Successful radiofrequency catheter ablation of congenital junctional ectopic tachycardia with preservation of atrioventricular conduction in a 9-month-old infant

An infant with congenital junctional ectopic tachyardia required frequent hospitalizations due to tachycardia acceleration despite multiple antiarrhythmic medications. At 9 months of age, he underwent successful radiofrequency catheter ablation of the tachycardia with preservation of AV conduction.

Transcatheter radiofrequency ablation for congenital junctional ectopic tachycardia in infancy

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.

Association of fetal junctional rhythm and respiratory arrhythmia detected by magnetocardiography

Magnetocardiographic recordings from a fetus at 34 weeks' gestation with a complex heart malformation revealed an unusual fetal arrhythmia, where the rhythm was observed to alternate between extended periods of sinus and junctional rhythms. Fetal heart rate measurement showed that the junctional rhythm was strongly associated with respiratory arrhythmia. We hypothesize that changes in autonomic balance due to the onset and cessation of fetal breathing movements were largely responsible for the rhythm alternations. To our knowledge this is the first report of a fetal junction rhythm and the first observation of fetal respiratory arrhythmia during nonsinus rhythm.

[Congenital ectopic junctional tachycardia: long-term remission after cryoablation of the bundle of His]

Congenital junctional ectopic tachycardia is an uncommon and potentially fatal arrhythmia that does not usually respond to medical therapy. We report a two month old infant with severe ventricular failure. The diagnosis was confirmed by electrophysiologic study. She underwent endocardial cryoablation of the His bundle during extracorporeal circulation and a ventricle epicardial-lead pacemaker was implanted. Eight years later the patient is still symptom-free without needing medical treatment.

[Idioventricular rhythm in childhood]

Idioventricular or accelerated ventricular rhythm has been reported frequently in adults--usually in association with acute myocardial infarction, sometimes in other heart diseases, but also in healthy individuals. Until today the origin of this rhythm disturbance is unknown, its nature benign and doesn't influence the prognosis adversely. The ectopic idioventricular rhythm was present intermittently, competed with the similar frequency of sinus rhythm and subdued by increasing the basic sinus rate was subdued. Such patients needs no therapy! The onset of idioventricular rhythm was observed in infancy and childhood too, but only a few reports exists. One case of idioventricular rhythm occurring in a 9-year-old girl is presented. In our opinion, cardiologic basic diagnostic methods (including echocardiography), Holter monitoring and possibly ergometry are sufficient to characterize this benign rhythm anomaly and to avoid unnecessary and perhaps dangerous treatment with antiarrhythmic drugs.

Efficacy and safety of propafenone in congenital junctional ectopic tachycardia

OBJECTIVES

Class IC antiarrhythmic drugs have recently been shown to be effective in some patients with atrial ectopic tachycardia. We therefore studied the efficacy of these drugs in patients with congenital junctional ectopic tachycardia.

BACKGROUND

Follow-up data on patients with junctional ectopic tachycardia suggest that this potentially lethal arrhythmia may cease spontaneously in a significant proportion of affected children. Therefore, temporary antiarrhythmic treatment appears to be the therapy of choice.

METHODS

The efficacy of propafenone was prospectively assessed in four infants with junctional ectopic tachycardia (ventricular rate 180, 185, 210 and 320 beats/min, respectively). The diagnosis of junctional ectopic tachycardia was established before the age of 2 months in all four infants. Propafenone was given orally in a mean dose of 350 (300 to 500) mg/m2 body surface area per day. Success of therapy was determined by serial electrocardiograms (ECGs) and Holter ambulatory ECG monitoring.

RESULTS

In two patients, junctional ectopic tachycardia was completely suppressed. In the remaining two patients, the tachycardia rate decreased to less than 150 beats/min. Serum propafenone levels did not correlate with efficacy of treatment. The mean duration of therapy was 18 months (range 3 to 36). No chemical or clinical side effects were noted.

CONCLUSIONS

Because of its effectiveness, safety and lack of side effects, propafenone appears to be a valuable drug in the treatment of junctional ectopic tachycardia in newborns and infants.

[Effectiveness of propafenone in congenital ectopic junctional tachycardia--a case report]

Junctional ectopic tachycardia is associated with a poor prognosis when it occurs in newborns and young infants. Like other automatic tachyarrhythmias, junctional ectopic tachycardia has been shown to be very resistant to medical treatment. Successful therapy with propafenone in a newborn with congenital junctional ectopic tachycardia is presented. Due to its high effectiveness, safety, and lack of side-effects, propafenone appears to be a valuable drug in the treatment of young patients with congenital junctional ectopic tachycardia.

Successful transcatheter ablation of congenital junctional ectopic tachycardia in a ten-month-old infant using radiofrequency energy

Congenital junctional tachycardia is a difficult-to-control rhythm in children which has a high mortality rate with current management. A 10-month-old child followed since birth with the diagnosis of congenital junctional ectopic tachycardia is reported. He failed treatment with multiple antiarrhythmic agents, and underwent an electrophysiology study. The junctional focus was successfully ablated using transcatheter radiofrequency energy. This technique may be safer than high voltage DC shock ablation, particularly in small children.

Evolving concepts in the management of congenital junctional ectopic tachycardia. A multicenter study

We reviewed the records of 26 infants with congenital junctional ectopic tachycardia (JET) from seven institutions to examine the evolution in the management of this tachycardia that is difficult to treat. JET was defined electrocardiographically as an incessant tachycardia with normal QRS morphology and atrioventricular (AV) dissociation. The ventricular rate ranged from 140 to 370 beats/min (mean, 230 beats/min); 16 of 26 patients had cardiac failure. Treatment success was defined as a stable decrease in the rate of JET, below 150 beats/min; partial success was a significant decrease of JET rate with alleviation of symptoms. All patients received digoxin with no significant effect. Propranolol was given to 16 patients, with two successes and one partial success. Combinations of other conventional agents were used in 11 patients with two successes; 14 patients were treated with amiodarone, which resulted in eight successes and three partial successes; three patients died suddenly on medical treatment (amiodarone, one patient; propranolol, one patient; or amiodarone plus propranolol, one patient); sudden AV block was a possible cause and consequently, two later patients had pacemaker implantation as well as medical treatment. His catheter ablation was successfully performed twice but contributed to death in a newborn; three surgical His ablations were performed for intractable JET with two successes and one death. The overall mortality was 35%. Among survivors, treatment has been stopped without any complications in five patients ranging in age from 10 months to 8 years (mean, 3.5 years). It seems that amiodarone alone is the best drug for treatment of congenital JET; necessity for permanent pacing remains unsettled. His ablation should be reserved only for intractable JET.