Document Detail


Transcatheter cryothermal ablation of junctional ectopic tachycardia in the normal heart.
MedLine Citation:
PMID:  16876738     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Junctional ectopic tachycardia in the normal heart is rare and often is resistant to pharmacologic management. Transcatheter ablation using radiofrequency energy places the AV node at risk. OBJECTIVES: The purpose of this study was to report our experience with transcatheter cryothermal ablation using three-dimensional mapping in six patients with junctional ectopic tachycardia. METHODS: A review of clinical and electrophysiologic data was performed on all patients with structurally normal hearts who underwent cryothermal ablation for treatment of junctional ectopic tachycardia at two institutions. RESULTS: Six patients (age 7.7-36.5 years) underwent attempted transcatheter cryothermal ablation using three-dimensional mapping. Only one patient had achieved arrhythmia suppression on medical management. Cryothermal mapping (-30 degrees C) localized the junctional focus while normal conduction was monitored. The junctional focus was high in the triangle of Koch in four patients and was low in one patient. The sixth patient had only one run of junctional ectopic tachycardia during the procedure and therefore received an empiric cryoablation (-70 degrees C) lesion. Subsequent cryoablation lesions were delivered at and around the junctional focus. In one patient, cryomapping eliminated the junctional focus but resulted in transient complete AV block; therefore, cryoablation was not performed. All patients who received the cryoablation lesions had elimination of their junctional ectopic tachycardia at 6-week follow-up. The patient who did not receive a cryoablation lesion remained in a slower junctional rhythm at follow-up. CONCLUSION: Cryoablation of junctional ectopic tachycardia is safe and effective. Nonetheless, proximity to the His-Purkinje system may preclude success. Empiric cryoablation can be effective; cryotherapy may not yield immediate success, but a delayed salutary effect can follow.
Authors:
Ian H Law; Nicholas H Von Bergen; Jean C Gingerich; Elizabeth V Saarel; Peter S Fischbach; Macdonald Dick
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2006-04-29
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  3     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-31     Completed Date:  2007-01-09     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  903-7     Citation Subset:  IM    
Affiliation:
Children's Hospital of Iowa, University of Iowa Hospitals and Clinics, Iowa City, 55242-1083, USA. ian-law@uiowa.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Body Surface Potential Mapping
Catheter Ablation*
Child
Cryosurgery*
Electrocardiography, Ambulatory
Electrophysiologic Techniques, Cardiac
Female
Follow-Up Studies
Heart Conduction System / pathology,  surgery
Humans
Imaging, Three-Dimensional
Iowa
Male
Michigan
Retrospective Studies
Tachycardia, Ectopic Junctional / physiopathology,  surgery*
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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