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Adenosine sensitive left ventricular summit ventricular tachycardia in a pre-adolescent: case report
Sunita J Ferns1, Melvin Scheinman2
1Department of Pediatrics, University of Illinois in Chicago, 420 NE Glen Oak Avenue, Suite 301, Peoria, IL 61603, USA.
European Heart Journal. Case Reports
|September 20, 2023
Summary
This case study highlights a rare instance of adenosine-sensitive ventricular tachycardia originating from the left ventricular summit in a pediatric patient. Successful ablation was achieved, offering a potential treatment for this challenging arrhythmia.
Area of Science:
- Cardiology
- Electrophysiology
- Pediatric Arrhythmia
Background:
- Left ventricular summit tachycardia is a rare and challenging arrhythmia.
- Adenosine-sensitive outflow tachycardias are facilitated by catecholamines and can be stress-induced.
- 12-lead electrocardiogram aids in localization, but complex anatomy poses challenges for precise origin prediction.
Observation:
- A 12-year-old female presented with recurrent wide-complex tachycardia, responsive to adenosine and esmolol.
- Episodes were exercise-induced and linked to beta-blocker non-compliance.
- An electrophysiology study identified an epicardial focus at the left ventricle summit.
Findings:
- The patient's ventricular tachycardia was successfully ablated from an epicardial focus at the left ventricle summit.
- The response to adenosine suggests a triggered mechanism, likely cAMP-mediated.
- This is the first reported case of left ventricular tachycardia due to cAMP-mediated triggered activity in this age group.
Implications:
- This case expands the understanding of pediatric ventricular tachycardia mechanisms.
- It underscores the importance of considering triggered activity in adenosine-sensitive arrhythmias.
- Successful ablation offers a curative option for this rare condition.
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