Successful Radiofrequency Catheter Ablation on ECMO in a Child with Double Tachycardia and Severe Cardiomyopathy

Sat, 5/3/08 - 12:34pm
0 Comments
2177 reads

Author(s):

Andrew D. Blaufox, MD and J. Philip Saul, MD

Tachycardia-induced cardiomyopathy is a well known phenomenon in the pediatric population.¹ However, at presentation, the coexistence of an incessantly elevated heart rate and ventricular dysfunction often sparks a chicken and egg debate. Determining causality can be even more perplexing if multiple arrhythmias are involved. Since radiofrequency ablation (RFA) is so effective at curing incessant pediatric tachyarrhythmias,^2-4 the best proof of causality may be restoration of acceptable hemodynamics in a compromised patient and eventual complete resolution of cardiomyopathy¹ after a reduction in heart rate is effected by an RFA procedure.

Thus, the potential reward of tachyarrhythmia elimination in this setting may lead to an attempt at RFA in even the sickest children who present with an incessantly elevated heart rate and cardiomyopathy. The following case illustrates the success of this strategy in an extreme circumstance where the patient presented with severe cardiomyopathy requiring support by extracorporeal membrane oxygenation (ECMO), and had both atrial and ventricular tachyarrhythmias.

Case Report

References:

1. Fishberger SB, Colan SD, Saul JP, et al. Myocardial mechanics before and after ablation of chronic tachycardia. Pacing & Clin Electrophysiol 1996;19:42-49.

2. Kugler JD. Radiofrequency catheter ablation for supraventricular tachycardia. Should it be used in infants and small children. Circulation 1994;90:639-641.

3. Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997;80:1438-1443.

4. Blaufox AD, Felix G, Saul JP. Radiofrequency catheter ablation in infants < 18 months old: When is it done and how do they fare? Short-term data from the Pediatric Ablation Registry. Circulation 2001;104:2803-2808.

5. Drucker NA, Colan SD, Lewis AB, et al. Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994;89:252-257.

6. Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med 1995;333:269-275.

7. Weindling SN, Saul JP, Walsh EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. Am Heart J 1996;131:66-72.

8. Booth KL, Roth SJ, Perry SB, et al. Cardiac catheterization of patients supported by extracorporeal membrane oxygenation. J Am Coll Cardiol 2002;40:1681-1686.

9. Zipes DP, Foster PR, Troup PJ, Pedersen DH. Atrial induction of ventricular tachycardia: Reentry versus triggered automaticity. Am J Cardiol 1979;44:1-8.