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

Successful cryoablation of junctional ectopic tachycardia is feasible in a 13.4kg, 18-month-old toddler

JET (junctional ectopic tachycardia) is a complicated and rare form of supraventricular tachycardia that is associated with a high rate of morbidity and mortality. Pharmaceutical management can be insufficient, and cryoablation has been described for congenital JET management. We describe cryoablation for congenital JET in an prior 32-week gestational aged, 18-month-old (corrected 16-month-old) with no JET post-ablation with normal Holter and follow-up within 6 months following cryoablation. This report demonstrates the safety and feasibility of cryoablation in patients as young as 18 months old.

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Cryoablation of congenital JET was safe for an 18-month-old (corrected gestational age 14 months) infant.

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Follow-up of 6 months demonstrated no recurrence of JET.

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The 4mm Cryo-catheter was a safe tool for JET ablation.

Junctional ectopic tachycardia in infants and children

Tachyarrhythmias originating in the atrioventricular (AV) node and AV junction including the bundle of His complex (BH) are called junctional tachycardia (JT) or junctional ectopic tachycardia (JET). Congenital JET (CJET) is a rare arrhythmia that occurs in patients without a preceding cardiac surgery and can be refractory to medical therapy and associated with high morbidity and mortality. CJET has a high rate of morbidity and mortality with death occurring in 35% of cases. JET occurring within 72 hours after cardiac surgery is referred to as postoperative JET (POJET) and caused by direct trauma, ischemic, or stretch injury to the AV conduction tissues during surgical repair of congenital heart defects. Focal junctional tachycardia (FJT) is also known as automatic junctional tachycardia and includes paroxysmal or non-paroxysmal forms. We discuss a staged approach to therapy with improved pharmacological therapies and the use of catheter-based therapies.

Outcomes of interventional electrophysiology in children under 2 years of age

BACKGROUND

Despite the increasing utilisation of interventional electrophysiology in adults and older children with arrhythmias, there are few data reflecting the safety and efficacy of this procedure in the age group under 2 years.

AIM

We describe our experience in assessing the efficacy and safety with this group of children.

METHODS

We undertook a retrospective review of all infants under 2 years of age who underwent an interventional electrophysiology procedure between 1995 and 2009 to determine indications, procedural details, short- and long-term success, and complication rate.

RESULTS

A total of 23 interventional electrophysiology procedures were performed in 17 patients initially under 2 years of age. Of these, three patients had congenital heart disease. The most common indication was arrhythmia resistant to pharmacological agents (59%), with the remaining cases being arrhythmia complicated by cardiovascular instability (41%). There was initial success in 15 patients after the first procedure, with early recurrence in four. Following six repeat procedures, there was long-term success in 15 patients (88%), with three repeat procedures being performed after 2 years of age. There was one non-procedural death related to persisting arrhythmia. There were three minor complications. In one patient, cryotherapy was used successfully.

CONCLUSIONS

The interventional electrophysiology procedure is a viable therapeutic option in infants under 2 years with arrhythmia resistant to other conventional medical management.