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[Infectious mitral endocarditis after radiofrequency catheter ablation of a left lateral accessory pathway]
F Benito Bartolomé1, C Sánchez Fernández-Bernal
1Unidad de Arritmias, Laboratorio de Electrofisiología Clínica Cardíaca, Hospital Universitario La Paz, Madrid. fbenito@gmx.net
Abstract:
A 2-years-old child with Wolff-Parkinson-White syndrome associated with life-threatening symptoms underwent radiofrequency ablation of a left lateral accessory pathway. A deflectable 5F bipolar electrode catheter positioned above the atrioventricular groove by transeptal approach was used for ablation. The catheters were repeatedly used after ethylene oxide sterilisation. Although immediate post-ablation echocardiography demonstrated no complications, the patient was readmitted two days later with fever and a new mitral murmur. Penicillin-susceptible Staphylococcus aureus was isolated and intravenous antibiotics were administered. In the following weeks, the patient developed constrictive pericarditis requiring surgical treatment and acute hemiplegia caused by brain embolism arising from valvular vegetation. At 5 years of follow-up the patient presents residual hemiparesia and grade II/IV mitral insufficiency.
Insights
Radiofrequency ablation for Wolff-Parkinson-White syndrome in a child led to serious complications including endocarditis and stroke. This case highlights the risks associated with repeated use of sterilized catheters.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Interventional Electrophysiology
Background:
- Wolff-Parkinson-White syndrome can cause life-threatening arrhythmias in children.
- Radiofrequency ablation is a common treatment for accessory pathways.
- Sterilization and reuse of medical devices require careful consideration.
Observation:
- A 2-year-old child with Wolff-Parkinson-White syndrome underwent radiofrequency ablation.
- The patient developed Staphylococcus aureus infection, constrictive pericarditis, and brain embolism post-procedure.
- Repeated use of ethylene oxide-sterilized catheters was noted.
Findings:
- The patient experienced severe complications including infective endocarditis and embolic stroke.
- Long-term sequelae included hemiparesis and mitral insufficiency.
- The case suggests a potential link between catheter reuse and infectious complications.
Implications:
- This case underscores the critical importance of infection control in pediatric electrophysiology.
- It raises concerns about the safety of repeated sterilization and use of ablation catheters.
- Further research into device-related infections and optimal sterilization protocols is warranted.