Catheter ablation of drug resistant supraventricular tachycardia in neonates and infants

Background: The aim of this study was to evaluate the indications, results and complicationsof radiofrequency ablation (RFA) and transcatheter cryoablation (TCA) in neonates andinfants with incessant drug-resistant supraventricular tachycardia (SVT).Methods: Out of 225 patients who underwent RFA and TCA at our center between January2010 and February 2012, 5 patients under the age of 1 (4 male, 1 female) were evaluated. Theindication for RFA/TCA was recurrent hemodynamically compromising drug-resistant SVT.Results: Over a 2-year period, 6 ablation procedures were performed in 5 patients. Averagepatient age was 3.3 ± 3.9 months (12 days – 9.5 months); average patient weight was 5.4 ± 2.2 kg (3.5–9 kg). One patient had ventricular septal defect, 1 had corrected transposition of great arteries, ventricular septal defect, right ventricular hypoplasia and pulmonary hypertension, while 3 had only patent foramen ovale. Electrophysiology study showed 1 accessory pathway in each patient (right posteroseptal in 2, left posteroseptal in 2 and left lateral in 1). The pathway was manifest in 1 patient with Wolff-Parkinson-White syndrome (WPW) andconcealed in the rest. Two of the concealed pathways had slow conduction time and decremental properties (the permanent form of junctional reciprocating tachycardia). Two patients underwentTCA and 3 — RFA, with an acute success rate of 100%. In the first week after the procedure, the patient with the complex cardiac anomaly and WPW developed recurrence and under went ablation again. Four of the procedures were carried out using an electroanatomic mapping system besides fluoroscopy. Average procedure time was 167 min (100–234); fluoroscopy time was 8.2 min (0.7–19.7). None of the patients developed major complications. After the average follow-upperiod of 6.5 months (3–18), all patients were symptom-free without medication.Conclusions: RFA and TCA can be performed successfully in neonates and infants within cessant medically refractory SVT

SU-PhysioDB: a physiological signals database for body area network security

This paper presents a new physiological signals database, SU-PhysioDB, that contains simultaneous measurements of electrocardiogram (ECG), blood pressure (BP) and body temperature (BT) signals. SU-PhysioDB can be used to evaluate the performance of the security mechanisms designed for the communication among the biosensors within Body Area Networks (BANs). We present a detailed description of our SU-PhysioDB database along with providing a performance comparison of two specific physiological parameter generation techniques using a public database and our SU-PhysioDB database. Results show that our SU-PhysioDB database is a pros-pering option to be used while evaluating the performance of a bio-cryptographic security infrastructure designed for BANs

Electrophysioloaical properties of asymptomatic children and adolescents with the Wolff-Parkinson-White electrocardiographic pattern

Amaç: Wolff–Parkinson–White (WPW) elektrokardiyografik paterni olan asemptomatik çocuk ve ergenlerde uygun yaklaşım konusunda halen çelişkiler bulunmaktadır. Bu çalışmada tamamen asemptomatik olan çocuk ve ergen WPW olgularının elektrofizyolojik özelliklerinin değerlendirilmesi amaçlandı. Yöntemler: Nisan 2012 ile Nisan 2018 süresince, invaziv elektrofizyolojik çalışma (EFÇ) ve kateter ablasyon uygulanmış, WPW paterni olan asemptomatik çocuk ve ergenlerin, tıbbi kayıtları ve işlem verileri değerlendirildi. Bulgular: Toplamda 149 EFÇ uygulanmış WPW paterni olan asemptomatik çocuk ve ergenin verileri geriye dönük olarak değerlendirildi. Hastaların 39’unda (%26.2) atriyal fibrilasyon esnasında en kısa pre-eksite geçen iki RR dalgası arasındaki mesafenin (SPERRI) ≤250 ms ya da aksesuvar yol efektif refrakter periyodunun (APERP) ≤270 ms olduğu saptandı. Riskli antegrad iletim saptanan 39 hastaya ve ortodromik atiyoventriküler taşikardi indüklenen 45 hastaya ablasyon uygulandı. Ek olarak aile isteği nedeniyle 14 hastaya da ablasyon uygulandı. Sonuç: Asemptomatik olan çocuk ve ergen WPW olgularının dörtte birinden fazlası, yüksek riskli antegrad iletim özellikleri sergilemektedir. Asemptomatik yüksek riskli çocuk ve ergen WPW olgularında ablasyon ilk sıra tedavi yöntemi olarak düşünülmelidir.Objective: Optimal management in asymptomatic children and adolescents with the Wolff-Parkinson-White (WPW) electrocardiographic pattern is still debatable. The aim of this retrospective study was to evaluate the electrophysiological properties of asymptomatic children and adolescents with WPW. Methods: The medical records and procedural data of asymptomatic children and adolescents with the WPW electrocardiographic pattern who underwent invasive electrophysiological study (EPS) and catheter ablation between April 2012 and April 2018 were evaluated. Results: In all, 149 consecutive, asymptomatic children and adolescents with WPW who underwent EPS were retrospectively investigated. In 39 (26.2%) of the patients, a shortest pre-excited R–R interval of ≤250 ms during atrial fibrillation or an accessory pathway effective refractory period of ≤270 ms was found. A total of 39 patients with high- -risk antegrade conduction and 45 patients with inducible orthodromic atrioventricular re-entrant tachycardia underwent catheter ablation. In addition, 14 patients underwent catheter ablation due to family preference. Conclusion: High-risk antegrade conduction properties are exhibited by more than one-quarter of asymptomatic children and adolescents with WPW. Ablation should be considered as a first-line therapy in asymptomatic children and adolescents with high-risk WPW

Unusual location of the AV Node in a patient with Wolf-Parkinson-White Syndrome and Primum ASD

Catheter ablation in patients with congenital heart disease can be very challenging. The anatomy of the conduction system can vary significantly. In this article, we present the catheter ablation procedure in a patient with primum ASD, Wolff-Parkinson-White syndrome and unusually located AV node

Electroanatomic mapping-guided catheter ablation of atrial tachycardia in children with limited/zero fluoroscopy

WOS: 000462873900008PubMed ID: 30740745Introduction Atrial tachycardia (AT) is an uncommon cause of supraventricular tachycardia in children and it is often resistant to medical therapy. Catheter ablation can be curative in children with AT. However, experience of ablation of pediatric AT is still very limited. The aim of this study, which is the largest series from a single center, was to assess the efficacy and safety of ablation of AT using an electroanatomical-mapping system. Methods It was a retrospective review of 39 children with AT who underwent catheter ablation procedure using the EnSite Velocity system (St. Jude Medical, St. Paul, MN, USA) between July 2012 and April 2017. Results The mean patient age was 13.32 +/- 6.82 years. The location of AT was right sided in 25 and left sided in 13, and both sides in one patient. The mean procedure time was 184.23 +/- 60.19 min. Fluoroscopy was not used in 25 of 39 patients. The mean fluoroscopy time in the remaining patients was 5.53 +/- 5.22 min. Radiofrequency (RF) ablation was used in 22, cryoablation was used in 10, and both RF and cryoablation were used in seven. Acute success was achieved in 34 patients (87.2%). During a mean follow-up of 51.35 +/- 12.62 months, AT recurred in five patients. These patients underwent second ablation procedures and four of them were successful. Final success was achieved in 33 out of 39 patients (84.6%). There were no complications except for one patient who had an uneventful pericardial needle injury during transseptal puncture without effusion. Conclusions Catheter ablation of AT in children can be performed safely and effectively with a limited fluoroscopy using electroanatomical mapping systems.Medipol UniversityThis work was supported by Medipol University through its institutional facilities

Flekainid Andersen-Tawil sendromlu pediyatrik hastalarda bidireksiyonel ventriküler taşikardiyi tamamen ortadan kaldırabilir mi?

WOS: 000453086300012PubMed ID: 30516532Andersen-Tawil syndrome (ATS) is a disorder that causes episodes of muscle weakness (periodic paralysis), changes in heart rhythm, and developmental abnormalities. QT prolongation and ventricular arrhythmias, including bidirectional ventricular tachycardia (VT) and polymorphic VT, may occur. About 60% of all cases of the disorder are caused by mutations in the KCNJ2 gene. A 13-year-old female patient was referred for frequent premature ventricular contractions. Suspicion of ATS due to dysmorphic findings, electrocardiogram changes, and periodic muscle weakness was genetically confirmed. Beta-blocker therapy was initiated as a first-line treatment for bidirectional VT and frequent polymorphic premature ventricular contractions. Despite proper treatment, the VT attacks were not brought under control. Flecainide was added to the treatment regime. The number of premature ventricular contractions was dramatically reduced with flecainide and the VT attacks completely disappeared. This patient is a rare example of ATS in our country. This article provides a description of successful management of rhythm disturbance in a patient with ATS.Andersen-Tawil sendromu (ATS), kas güçsüzlüğü(periyodik paralizi), ritm bozuklukları ve gelişim bozukluklarına neden olan bir hastalıktır. QT uzaması ve bidireksiyonel ventriküler taşikardi (VT) ve polimorfik VT’yide içeren ventriküler aritmiler ortaya çıkabilir. Tüm olguların yaklaşık %60’ı, KCNJ2 genindeki mutasyonlardankaynaklanmaktadır. On üç yaşında kız hasta, sık ventriküler erken atımlar nedeniyle hastanemize sevk edildi.Hasta, morfolojik bozuklukları, EKG değişiklikleri ve periyodik kas güçsüzlüğü nedeniyle ATS olarak düşünüldüve tanı genetik olarak doğrulandı. Bidireksiyonel VT vesık polimorfik erken ventriküler atımları için ilk basamak tedavi olarak beta bloker başlandı. Ancak tedaviyerağmen, hastanın VT atakları kontrol altına alınamadı.Bunun üzerine Flekainid tedaviye eklendi. Flekainid ileprematüre ventriküler atımların sayısı çarpıcı bir şekildeazaldı. Ayrıca VT atakları tamamen kayboldu. Bu hasta, ülkemizde nadir görülen ATS’li hastalardan biridir. Bumakalede ATS’li bir hastada ritm bozukluğunun başarılıyönetimi anlatılmıştır

Percutaneous closure of large VSD using a home-made fenestrated atrial septal occluder in 18-year-old with pulmonary hypertension

Background: Hemodynamically significant muscular ventricular septal defects in children after the infantile period are a rare occurrence and ideal for transcatheter closure. In cases of severe concomitant pulmonary hypertension, it may be necessary to fenestrate the device. In this report, we present an 18-year old patient with a large mid-trabecular ventricular septal defect and severe pulmonary hypertension that underwent percutaneous closure of the defect with a home-made fenestrated atrial septal occluder.Case presentation: An 18-year-old female patient referred to us with complaints of dyspnea (NYHA score of 2-3). Physical examination revealed an apical rumble and a harsh second heart sound. Echocardiographic examination revealed a large mid-trabecular ventricular septal defect with bidirectional shunt and the widest diameter measuring 22 mm on 2D echocardiography. Left and right heart cavities were enlarged. Before and after the vasoreactivity test performed during cardiac catheterization, average aortic pressure was 65 › 86 mmHg, average pulmonary artery pressure: 58 › 73 mmHg, Qp/Qs: 1.6 › 3.2, PVR: 4.6 › 4.3 Wood/U/m2 and PVR/SVR: 0.5 › 0.2. On left-ventricular angiocardiogram, the largest end-diastolic defect diameter was 21 mm. The closure procedure was performed with transthoracic echocardiographic guidance, using a 24 mm Cera septal occluder and a 14 F sheath dilator to make a 4.5-5 mm opening. Measured immediately after the procedure and during cardiac catheterization one month later, average aortic pressure was 75 › 75 mmHg, average pulmonary artery pressure: 66 › 30 mmHg, Qp/Qs 1.5 › 1.4, PVR: 4.4 › 2.9 Wood/U/m2 and PVR/SVR: 0.4 › 0.2. Transthoracic echocardiographic examination performed 24 hours after the procedure showed a max 35-40 mmHg gradient between the left and right ventricles through the fenestration. After the procedure, we observed sporadic early ventricular systoles and a nodal rhythm disorder that started after approximately 12 hours and spontaneously reverted to normal 9 days later.Conclusion: In patients with large ventricular septal defects, large atrial septal occluders may be used. In cases with risk of pulmonary vascular disease, a safer option would be to close the defect using a manually fenestrated device

A rare association with suffered cardiac arrest, long qt interval, and syndactyly: Timothy syndrome (LQT-8)

Timothy syndrome (TS), also referred to as syndactylyassociated long QT syndrome (LQTS) or LQT8, is a multi-system disorder characterized by developmental defects causing dysmorphic facial features, congenital heart abnormalities, neurocognitive impairment, and webbing of the toes and fingers (syndactyly) (1). TS is caused by mutations of the CACNA1C gene, which encodes L-type calcium channel Ca (V) 1.2. Two types of TS have been defined according to the mutation sites: G406R in exon 8A (TS1) and G402S/G406R in exon 8 (TS2). These gain-offunction mutations result in an impaired open-state and voltagedependent inactivation of the L-type calcium channel, ultimately 672 Case Reports Anatol J Cardiol 2015; 15: 671-4 leading to a markedly prolonged myocardial action potential (delayed ventricular repolarization) (1-4)