Abstract
Advances in electroanatomic mapping (EAM) technology have facilitated improved success and safety profiles in the field of catheter ablation. However, these advances in their current iteration may be of limited value in ablation performed in very small children. The present case report highlights the application of current EAM technologies in an infant with incessant arrhythmias and includes a discussion regarding the application and limitations of newer mapping and ablation technologies in this unique and fragile patient group.
Highlights
A three-month-old, 4.2-kg infant was brought to the electrophysiology (EP) laboratory for EP testing and catheter ablation of prenatally diagnosed and postnatally recalcitrant atrial tachycardia
Focal ectopic atrial tachycardia was documented on 12-lead electrocardiogram (Figure 1)
Technology has since progressed to these systems providing real-time visualization of multiple catheters within the cardiac and intravascular spaces; sophisticated cardiac geometry creation with the integration of intracardiac echocardiogram, computed tomography, or magnetic resonance imaging data; dense and rapid mapping of complex arrhythmias within heterogeneous myocardial substrates; real-time monitoring of catheter-tip pressure during ablation delivery; and visualization tools permitting the performance of procedures with very little or no fluoroscopy.[1,2,3,4,5]
Summary
A three-month-old, 4.2-kg infant (full term, birth weight: 3.5 kg) was brought to the electrophysiology (EP) laboratory for EP testing and catheter ablation of prenatally diagnosed and postnatally recalcitrant atrial tachycardia. Additional complicating events included recurrent bloody stools (concerning for necrotizing enterocolitis, gut hypoperfusion during incessant tachycardia, or dietary allergies), aspiration and ventilator-associated pneumonias, and urinary tract infection. This made enteral medication administration difficult and inconsistent. Right versus left atrial positioning during mapping, and to monitor catheter course and stability during ablation. While simultaneous multipoint acquisition could be used for initial geometry creation, point-by-point contact activation mapping was performed instead with the ablation catheter. The catheter tip was adjusted slightly superiorly and a 20-second RF application, this time with a 30-W maximum power delivery, resulted in tachycardia termination in six seconds without further recurrence (Figure 2C). The catheters and sheaths were removed at the conclusion of the procedure
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