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Updated: Jul 18, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
SUCCESSFUL ABLATION OF CONCEALED ACCESSORY PATHWAY MEDIATED SUPRAVENTRICULAR TACHYCARDIA IN A 5-YEAR-OLD CHILD WITH
Nikola Krmek1, Vladimir Jegdić2, Mirta Rode1
1Sestre milosrdnice University Hospital Center, Zagreb, Croatia.
Insights
This case study highlights successful radiofrequency ablation for supraventricular tachycardia in a child with Ebstein anomaly. The procedure effectively treated the arrhythmia without requiring X-ray or intracardiac echocardiography.
Area of Science:
- Pediatric Cardiology
- Electrophysiology
- Congenital Heart Disease
Background:
- Ebstein anomaly is a rare congenital heart defect affecting the tricuspid valve.
- Supraventricular tachycardia (SVT) is a common arrhythmia associated with Ebstein anomaly.
- Management of SVT in this population can be challenging.
Observation:
- A 5-year-old boy with Ebstein anomaly presented with recurrent supraventricular tachycardia.
- Electrophysiology study revealed atrioventricular reentry tachycardia originating from the posteroseptal region of the tricuspid annulus.
- The patient had a history of afebrile convulsions and was previously treated with atenolol.
Findings:
- Radiofrequency catheter ablation successfully targeted and eliminated the accessory pathway responsible for the SVT.
- The ablation was performed without the use of X-ray fluoroscopy or intracardiac echocardiography.
- Post-ablation electrocardiogram showed no significant changes, and the patient remained free of tachycardia during follow-up.
Implications:
- Catheter ablation is a safe and effective treatment for supraventricular tachycardia in pediatric patients with Ebstein anomaly.
- Minimally invasive ablation techniques can be utilized in this complex patient population.
- This approach offers an alternative to traditional methods, potentially reducing radiation exposure and procedural risks.
Abstract:
Here we report a case of a 5-year-old boy with Ebstein anomaly and supraventricular tachycardia. He was diagnosed with Ebstein anomaly at the age of 3 months during the workup for afebrile convulsions, and has been followed by a pediatric cardiologist since. Electrocardiography recorded a small Rr` pattern in V1 on a few occasions, without other abnormalities. At the age of 2.5 years, the first episode of supraventricular tachycardia was recorded and stopped with adenosine. He was started on atenolol and was asymptomatic until a year later when he presented with the second recorded supraventricular tachycardia. He was referred to our institution for an electrophysiology study with ablation. Tachycardia was entrained and all the maneuvers were in accordance with atrioventricular reentry tachycardia. Tricuspid annulus was mapped during tachycardia. The earliest atrial signals appeared in the posteroseptal region of the valve, mechanical blocking of the tachycardia was recorded in that region, and early fractionated signal was present during ventricular retrograde pacing. The pathway was successfully ablated. Basal electrocardiogram was without change after ablation and the patient did not experience recurrence of tachycardia during follow-up. This case shows the efficacy and importance of ablation in Ebstein anomaly, without x-ray or intracardiac echocardiography.
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