Tachycardiac storm in infant with WPW syndrome: "rescue" radiofrequency ablation
Kiran Chandan1, Yash Lokhandwala, C K Ponde
1Department of Cardiology, P.D. Hinduja Hospital and Medical Research Center and Glenmark Cardiac Centre, Mumbai 400 016, India.
Indian Pediatrics
|May 28, 2003
Insights
A pediatric patient with Wolff-Parkinson-White (WPW) syndrome and orthodromic tachycardia underwent successful ablation of a left-sided accessory pathway. This intervention resolved frequent tachycardia episodes unresponsive to antiarrhythmic drugs.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Wolff-Parkinson-White (WPW) syndrome is a common cause of supraventricular tachycardia in infants.
- Orthodromic tachycardia in WPW syndrome can be challenging to manage, particularly in neonates.
- Medical management with antiarrhythmic drugs like digoxin, flecainide, and amiodarone is often the first line of treatment.
Observation:
- A two-month-old infant with WPW syndrome presented with persistent, severe, and frequent orthodromic tachycardia.
- The infant's condition remained refractory despite treatment with digoxin, flecainide, and amiodarone.
- This clinical scenario indicated a need for alternative therapeutic strategies.
Findings:
- Catheter ablation targeting the left-sided accessory pathway was performed.
- A patent foramen ovale was utilized as an access route for the ablation procedure.
- Successful ablation led to the resolution of the patient's tachycardia episodes.
Implications:
- Transcatheter ablation via a patent foramen ovale is a viable and effective treatment for refractory WPW syndrome in infants.
- This approach offers a minimally invasive alternative to surgical intervention for complex pediatric arrhythmias.
- Early and successful ablation can significantly improve the quality of life and long-term prognosis for infants with WPW syndrome.
Abstract:
A two-month-old child having WPW syndrome and orthodromic tachycardia was on treatment with digoxin, flecainide and amiodarone. Despite this, he continued to have severe, very frequent episodes of tachycardia. The left-sided accessory pathway was hence ablated via a patent foramen ovale.
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