Radiofrequency catheter ablation in a child with Wolff-Parkinson-White syndrome and congenitally corrected transposition of the great arteries

The case is presented of a five-year-old boy with Wolff-Parkinson-White syndrome, who had undergone three surgical palliations because of congenitally corrected transposition of the great arteries, ventricular septal defect and pulmonary trunk near-atresia. Successful and uncomplicated radiofrequency catheter ablation of an accessory pathway located across the systemic atrioventricular valve ring was performed. The procedure was motivated by forthcoming corrective surgery, which would preclude venous access to the heart. This case emphasizes the need for precise timing of ablative therapy in such patients and shows that surgery itself may facilitate catheter ablation. (Cardiol J 2007; 14: 500-503

Interventional electrophysiology in Bulgaria in 2023: data from the electronic registry BG-EPHY

This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) cardiac ablations in 2023. Material and methods. This is a retrospective study of a full one-year sample of the BG-EPHY registry. Sex and age distribution of the patients, number of ablations, use of electroanatomic mapping (EAM), irrigated and cryoablations, distribution of different types of arrhythmias, acute procedural success, and complications are presented. Results. In 2023 nine EP centers performed 2021 ablations in 1309 men (61.8%) and 807 women, incl. 20 ablations in pediatric patients (1%). EAM was used in 941 procedures (46.6%), irrigated-tip catheter – in 1121 (55.5%), cryocatheter – in 420 (20.8%), and intracardiac echocardiography – in 43 (2.1%). The most frequently performed ablation was pulmonary vein isolation (46.4%), followed by ablation for AV nodal reentrant tachycardia (16.3%) and typical atrial flutter (15.2%). The acute success was over 98%, while intraprocedural complications were less than 2%. Conclusion. The national registry of electrophysiology collects systematically and continuously basic data on all ablations of cardiac arrhythmias performed in  the country. In 2023, after the end of the COVID-19 pandemic, the number of ablations increased compared to 2022, but at a slightly slower rate. Distribution of EP procedure types was similar to previous years. Acute success was very high, while intraprocedural complications were rare.&nbsp

Zabieg ablacji prądem o wysokiej częstotliwości u dziecka z zespołem Wolffa-Parkinsona-White’a oraz wrodzonym skorygowanym przełożeniem wielkich pni tętniczych

W niniejszej pracy przedstawiono przypadek kliniczny 5-letniego chłopca chorującego na zespół Wolffa-Parkinsona-White’a, który dotychczas przeszedł trzy paliatywne operacje kardiochirurgiczne z powodu wrodzonego skorygowanego przełożenia wielkich pni tętniczych, otworu w przegrodzie międzykomorowej oraz niepełnej atrezji pnia płucnego. Wykonano ablację prądem o wysokiej częstotliwości drogi dodatkowej zlokalizowanej w poprzek pierścienia systemowej zastawki przedsionkowo-komorowej. Zabieg przebiegał bez powikłań i zakończył się sukcesem. Czas wykonania zabiegu przyspieszono ze względu na zaplanowany kolejny kardiochirurgiczny zabieg paliatywny, który wykluczyłby dożylny dostęp do jam mięśnia sercowego. Opis tego przypadku podnosi ważną kwestię precyzyjnego określenia czasu wykonania zabiegu ablacyjnego u takich chorych oraz ukazuje fakt, że zabieg kardiochirurgiczny sam w sobie może ułatwić zabieg ablacyjny. (Folia Cardiologica Excerpta 2008; 3: 50-54

Preventing complicated transseptal puncture with intracardiac echocardiography: case report

BACKGROUND: Recently, intracardiac echocardiography emerged as a useful tool in the electrophysiology laboratories for guiding transseptal left heart catheterizations, for avoiding thromboembolic and mechanical complications and assessing the ablation lesions characteristics. Although the value of ICE is well known, it is not a universal tool for achieving uncomplicated access to the left atrium. We present a case in which ICE led to interruption of a transseptal procedure because several risk factors for mechanical complications were revealed. CASE PRESENTATION: A case of a patient with paroxysmal atrial fibrillation and atrial flutter, and distorted intracardiac anatomy is presented. Intracardiac echocardiography showed a small oval fossa abouting to an enlarged aorta anteriorly. A very small distance from the interatrial septum to the left atrial free wall was seen. The latter two conditions were predisposing to a complicated transseptal puncture. According to fluoroscopy the transseptal needle had a correct position, but the intracardiac echo image showed that it was actually pointing towards the aortic root and most importantly, that it was virtually impossible to stabilize it in the fossa itself. Based on intracardiac echo findings a decision was made to limit the procedure only to ablation of the cavotricuspid isthmus and not to proceed further so as to avoid complications. CONCLUSION: This case report illustrates the usefulness of the intracardiac echocardiography in preventing serious or even fatal complications in transseptal procedures when the cardiac anatomy is unusual or distorted. It also helps to understand the possible mechanisms of mechanical complications in cases where fluoroscopic images are apparently normal

Mid-term echocardiographic follow up of left ventricular function with permanent right ventricular pacing in pediatric patients with and without structural heart disease

BACKGROUND: Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction. METHODS: A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 ± 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V(5 )or II on standard 12-lead electrocardiogram. RESULTS: Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 ± 0.07 vs 0.35 ± 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation. CONCLUSION: Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease

Chronic ventricular pacing in children: toward prevention of pacing-induced heart disease

In children with congenital or acquired complete atrioventricular (AV) block, ventricular pacing is indicated to increase heart rate. Ventricular pacing is highly beneficial in these patients, but an important side effect is that it induces abnormal electrical activation patterns. Traditionally, ventricular pacemaker leads are positioned at the right ventricle (RV). The dyssynchronous pattern of ventricular activation due to RV pacing is associated with an acute and chronic impairment of left ventricular (LV) function, structural remodeling of the LV, and increased risk of heart failure. Since the degree of pacing-induced dyssynchrony varies between the different pacing sites, ‘optimal-site pacing’ should aim at the prevention of mechanical dyssynchrony. Especially in children, generally paced from a very early age and having a perspective of life-long pacing, the preservation of cardiac function during chronic ventricular pacing should take high priority. In the perspective of the (patho)physiology of ventricular pacing and the importance of the sequence of activation, this paper provides an overview of the current knowledge regarding possible alternative sites for chronic ventricular pacing. Furthermore, clinical implications and practical concerns of the various pacing sites are discussed. The review concludes with recommendations for optimal-site pacing in children

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

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Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF