Skip to main content
Erschienen in: Pediatric Cardiology 7/2013

01.10.2013 | Original Article

Impact of Transesophageal Electrophysiologic Study to Elucidate the Mechanism of Arrhythmia on Children With Supraventricular Tachycardia and No Preexcitation

verfasst von: Béatrice Brembilla-Perrot, A. Moulin-Zinsch, J. M. Sellal, J. Schwartz, A. Olivier, P. Y. Zinzius, C. De Chillou, D. Beurrier, M. Rodermann, G. Goudote, H. Al Amoura, A. Terrier de la Chaise, J. Lemoine, J. Rizk, J. P. Lethor, J. L. Anne Tisserand, S. Taïhi, F. Marçon

Erschienen in: Pediatric Cardiology | Ausgabe 7/2013

Einloggen, um Zugang zu erhalten

Abstract

An electrophysiologic study (EPS) of children and teenagers with paroxysmal supraventricular tachycardia (SVT) and normal electrocardiography (ECG) in sinus rhythm was evaluated. Generally, EPS is performed only before paroxysmal SVT ablation in these patients. In this study, 140 patients (mean age, 15 ± 3 years) with normal ECG in sinus rhythm were studied for SVT by a transesophageal route in baseline state and after isoproterenol. Idiopathic left or right ventricular tachycardia was diagnosed in four patients (3 %). Anterograde conduction over an atrioventricular (AV) left lateral (n = 10) or septal (n = 9) accessory pathway (AP) was noted in 19 patients (13.5 %) at atrial pacing. Orthodromic AV reentrant tachycardia (AVRT) was induced in these children. Five of the patients had a high rate conducted over AP (>240 bpm in baseline state or >290 bpm after isoproterenol). Two of the patients (a 10-year-old girl with well-tolerated SVT and a 17-year-old with syncope-related SVT) had the criteria for a malignant form with the induction of atrial fibrillation conducted over AP at a rate exceeding 290 bpm in baseline state. Of the 140 patients, 74 (53 %) had typical AV node reentrant tachycardia (AVNRT), nine had atypical AVNRT (6 %), 1 had atrial tachycardia (0.7 %), and 33 (23.5 %) had AVRT related to a concealed AP with only retrograde conduction. Electrophysiologic study is recommended for children with paroxysmal SVT and normal ECG in sinus rhythm. The data are helpful for guiding the treatment. Ventricular tachycardia or atrial tachycardia can be misdiagnosed. Masked preexcitation syndrome with anterograde conduction through AP was present in 13.5 % of the patients, and 1.4 % had a malignant preexcitation syndrome.
Literatur
1.
Zurück zum Zitat Bacher K, Bogaert E, Lapere R, De Wolf D, Thierens H (2005) Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 111:83–89CrossRefPubMed Bacher K, Bogaert E, Lapere R, De Wolf D, Thierens H (2005) Patient-specific dose and radiation risk estimation in pediatric cardiac catheterization. Circulation 111:83–89CrossRefPubMed
2.
Zurück zum Zitat Blaufox AD, Warsy I, D’Souza M, Kanter R (2011) Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy. Pediatr Cardiol 32:1110–1114CrossRefPubMed Blaufox AD, Warsy I, D’Souza M, Kanter R (2011) Transesophageal electrophysiological evaluation of children with a history of supraventricular tachycardia in infancy. Pediatr Cardiol 32:1110–1114CrossRefPubMed
3.
Zurück zum Zitat Brembilla-Perrot B (1999) Study of P wave morphology in lead V1 during supraventricular tachycardia for localizing the reentrant circuit. Am Heart J 65:522–530 Brembilla-Perrot B (1999) Study of P wave morphology in lead V1 during supraventricular tachycardia for localizing the reentrant circuit. Am Heart J 65:522–530
4.
Zurück zum Zitat Brembilla-Perrot B, Spatz F, Khaldi E, Terrier de la Chaise A, Le Van D, Pernot C (1990) Value of esophageal pacing in evaluation of supraventricular tachycardia. Am J Cardiol 65:322–330CrossRefPubMed Brembilla-Perrot B, Spatz F, Khaldi E, Terrier de la Chaise A, Le Van D, Pernot C (1990) Value of esophageal pacing in evaluation of supraventricular tachycardia. Am J Cardiol 65:322–330CrossRefPubMed
5.
Zurück zum Zitat Brembilla-Perrot B, Beurrier D, Houriez P, Claudon O, Wertheimer J (2001) Incidence and mechanism of presyncope and/or syncope associated with paroxysmal junctional tachycardia. Am J Cardiol 88:134–138CrossRefPubMed Brembilla-Perrot B, Beurrier D, Houriez P, Claudon O, Wertheimer J (2001) Incidence and mechanism of presyncope and/or syncope associated with paroxysmal junctional tachycardia. Am J Cardiol 88:134–138CrossRefPubMed
6.
Zurück zum Zitat Brembilla-Perrot B, Groben L, Chometon F, Lethor JP, Admant P, Cloez JL, Popescu I, Marchal C, Cedano J, Abdelaal A, Huttin O, Tatar C, Benzaghou N, Azman B, Terrier de la Chaise A, Marçon F (2009) Rapid and low-cost method to prove the nature of no documented tachycardia in children and teenagers without pre-excitation syndrome. Europace 11:1083–1089CrossRefPubMed Brembilla-Perrot B, Groben L, Chometon F, Lethor JP, Admant P, Cloez JL, Popescu I, Marchal C, Cedano J, Abdelaal A, Huttin O, Tatar C, Benzaghou N, Azman B, Terrier de la Chaise A, Marçon F (2009) Rapid and low-cost method to prove the nature of no documented tachycardia in children and teenagers without pre-excitation syndrome. Europace 11:1083–1089CrossRefPubMed
7.
Zurück zum Zitat Brembilla-Perrot B, Valizadeh Moejezi R, Zinzius PY, Jarmouni S, Schwartz J, Beurrier D, Sellal JM, Nossier I, Muresan L, Andronache M, Moisei R, Selton O, Louis P, Terrier de la Chaise A (2013) Missing diagnosis of preexcitation syndrome on ECG: clinical and electrophysiological significance. Int J Cardiol 163:288–293CrossRefPubMed Brembilla-Perrot B, Valizadeh Moejezi R, Zinzius PY, Jarmouni S, Schwartz J, Beurrier D, Sellal JM, Nossier I, Muresan L, Andronache M, Moisei R, Selton O, Louis P, Terrier de la Chaise A (2013) Missing diagnosis of preexcitation syndrome on ECG: clinical and electrophysiological significance. Int J Cardiol 163:288–293CrossRefPubMed
8.
Zurück zum Zitat D’este D, Zoppo F, Bertaglia E, Zerbo F, Picciolo A, Scarabeo V, Pascotto A, Pascotto P (2007) Long-term outcome of patients with atrioventricular node reentrant tachycardia. Int J Cardiol 115:350–353CrossRefPubMed D’este D, Zoppo F, Bertaglia E, Zerbo F, Picciolo A, Scarabeo V, Pascotto A, Pascotto P (2007) Long-term outcome of patients with atrioventricular node reentrant tachycardia. Int J Cardiol 115:350–353CrossRefPubMed
9.
Zurück zum Zitat Erdoğan I, Ozer S, Karagöz T, Sahin M, Celiker A (2009) Clinical importance of transesophageal electrophysiologic study in the management of supraventricular tachycardia in children. Turk J Pediatr 51:578–581PubMed Erdoğan I, Ozer S, Karagöz T, Sahin M, Celiker A (2009) Clinical importance of transesophageal electrophysiologic study in the management of supraventricular tachycardia in children. Turk J Pediatr 51:578–581PubMed
10.
Zurück zum Zitat Garson A Jr, Gillette PC (1981) Electrophysiologic studies of supraventricular tachycardia in children. I Clinical-electrophysiologic correlations. Am Heart J 102:233–250CrossRefPubMed Garson A Jr, Gillette PC (1981) Electrophysiologic studies of supraventricular tachycardia in children. I Clinical-electrophysiologic correlations. Am Heart J 102:233–250CrossRefPubMed
11.
Zurück zum Zitat German LD, Packer DL, Bardy GH, Gallagher JJ (1983) Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. Am J Cardiol 52:1202–1207CrossRefPubMed German LD, Packer DL, Bardy GH, Gallagher JJ (1983) Ventricular tachycardia induced by atrial stimulation in patients without symptomatic cardiac disease. Am J Cardiol 52:1202–1207CrossRefPubMed
12.
Zurück zum Zitat Gulamhusein S, Ko P, Carruthers SG, Klein GJ (1982) Acceleration of the ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome after verapamil. Circulation 65:348–354CrossRefPubMed Gulamhusein S, Ko P, Carruthers SG, Klein GJ (1982) Acceleration of the ventricular response during atrial fibrillation in the Wolff-Parkinson-White syndrome after verapamil. Circulation 65:348–354CrossRefPubMed
13.
Zurück zum Zitat Ko JK, Deal BJ, Strasburger JF, Benson DW Jr (1992) Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 69:1028–1032CrossRefPubMed Ko JK, Deal BJ, Strasburger JF, Benson DW Jr (1992) Supraventricular tachycardia mechanisms and their age distribution in pediatric patients. Am J Cardiol 69:1028–1032CrossRefPubMed
14.
Zurück zum Zitat Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Pluta S, Sokal A, Lenarczyk A, Zeifert B, Szkutnik M, Białkowski J, Kalarus Z (2009) Radiofrequency catheter ablation in the treatment of arrhythmias in children efficacy, safety of the method, predictors of the procedural course and acute success. Przegl Lek 66:418–423PubMed Lenarczyk R, Kowalski O, Pruszkowska-Skrzep P, Pluta S, Sokal A, Lenarczyk A, Zeifert B, Szkutnik M, Białkowski J, Kalarus Z (2009) Radiofrequency catheter ablation in the treatment of arrhythmias in children efficacy, safety of the method, predictors of the procedural course and acute success. Przegl Lek 66:418–423PubMed
15.
Zurück zum Zitat Liberman L, Pass RH, Starc TJ (2008) Optimal surface electrocardiogram lead for identification of the mechanism of supraventricular tachycardia in children. Pediatr Emerg Care 24:28–30CrossRefPubMed Liberman L, Pass RH, Starc TJ (2008) Optimal surface electrocardiogram lead for identification of the mechanism of supraventricular tachycardia in children. Pediatr Emerg Care 24:28–30CrossRefPubMed
16.
Zurück zum Zitat McGovern B, Garan H, Ruskin JN (1986) Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome. Ann Intern Med 104:791–794CrossRefPubMed McGovern B, Garan H, Ruskin JN (1986) Precipitation of cardiac arrest by verapamil in patients with Wolff-Parkinson-White syndrome. Ann Intern Med 104:791–794CrossRefPubMed
17.
Zurück zum Zitat Orejarena LA, Vidaillet H, De Stefano F, Nordstrom DL, Vierkant RA, Smith PN, Hayes JJ (1998) Paroxysmal supraventricular tachcyardia in general population. J Am Coll Cardiol 31:150–157CrossRefPubMed Orejarena LA, Vidaillet H, De Stefano F, Nordstrom DL, Vierkant RA, Smith PN, Hayes JJ (1998) Paroxysmal supraventricular tachcyardia in general population. J Am Coll Cardiol 31:150–157CrossRefPubMed
18.
Zurück zum Zitat Pappone C, Manguso F, Santinelli V, Vicedomini G, Sala S, Paglino G, Mazzone P, Lang CC, Gulletta S, Augello G, Santinelli O, Santinelli V (2004) Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 351:1197–1205CrossRefPubMed Pappone C, Manguso F, Santinelli V, Vicedomini G, Sala S, Paglino G, Mazzone P, Lang CC, Gulletta S, Augello G, Santinelli O, Santinelli V (2004) Radiofrequency ablation in children with asymptomatic Wolff-Parkinson-White syndrome. N Engl J Med 351:1197–1205CrossRefPubMed
19.
Zurück zum Zitat Pfammatter JP, Paul T (1999) Idiopathic ventricular tachycardia in infancy and childhood. J Am Coll Cardiol 33:2067–2072CrossRefPubMed Pfammatter JP, Paul T (1999) Idiopathic ventricular tachycardia in infancy and childhood. J Am Coll Cardiol 33:2067–2072CrossRefPubMed
20.
Zurück zum Zitat Pongiglione G, Saul P, Dunnigan A, Strasburger JF, Benson DW (1988) Role of transesophageal pacing in evaluation of palpitations in children and adolescents. Am J Cardiol 66:566–570CrossRef Pongiglione G, Saul P, Dunnigan A, Strasburger JF, Benson DW (1988) Role of transesophageal pacing in evaluation of palpitations in children and adolescents. Am J Cardiol 66:566–570CrossRef
21.
Zurück zum Zitat Rhodes LA, Walsh EP, Saul JP (1994) Programmed atrial stimulation via the esophagus for management of supraventricular arrhythmias in infants and children. Am J Cardiol 74:353–356CrossRefPubMed Rhodes LA, Walsh EP, Saul JP (1994) Programmed atrial stimulation via the esophagus for management of supraventricular arrhythmias in infants and children. Am J Cardiol 74:353–356CrossRefPubMed
22.
Zurück zum Zitat Samson RA, Deal BJ, Strasburger JF, Benson DW Jr (1995) Comparison of transesophageal and intracardiac electrophysiologic studies in characterization of supraventricular tachycardia in pediatric patients. J Am Coll Cardiol 26:159–163CrossRefPubMed Samson RA, Deal BJ, Strasburger JF, Benson DW Jr (1995) Comparison of transesophageal and intracardiac electrophysiologic studies in characterization of supraventricular tachycardia in pediatric patients. J Am Coll Cardiol 26:159–163CrossRefPubMed
23.
Zurück zum Zitat Tomaske M, Candinas R, Weiss M, Bauersfeld U (2011) Safety and efficacy of paediatric outpatient radiofrequency catheter ablations. Int J Cardiol 148:276–279CrossRefPubMed Tomaske M, Candinas R, Weiss M, Bauersfeld U (2011) Safety and efficacy of paediatric outpatient radiofrequency catheter ablations. Int J Cardiol 148:276–279CrossRefPubMed
24.
Zurück zum Zitat Van Hare GV, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G (2004) Participating members of the pediatric electrophysiology society: prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 1:188–196PubMedCentralCrossRefPubMed Van Hare GV, Javitz H, Carmelli D, Saul JP, Tanel RE, Fischbach PS, Kanter RJ, Schaffer M, Dunnigan A, Colan S, Serwer G (2004) Participating members of the pediatric electrophysiology society: prospective assessment after pediatric cardiac ablation: recurrence at 1 year after initially successful ablation of supraventricular tachycardia. Heart Rhythm 1:188–196PubMedCentralCrossRefPubMed
25.
Zurück zum Zitat Vignati G, Balla E, Mauri L, Launati M, Figini A (2000) Clinical and electrophysiologic evolution of the Wolff-Parkinson-White syndrome in children: impact on approaches to management. Cardiol Young 10:303–306 Vignati G, Balla E, Mauri L, Launati M, Figini A (2000) Clinical and electrophysiologic evolution of the Wolff-Parkinson-White syndrome in children: impact on approaches to management. Cardiol Young 10:303–306
26.
Zurück zum Zitat Vitello R, McCrindle BW, Nykanen D, Freedom RM, Benson L (1998) Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 32:1243–1244 Vitello R, McCrindle BW, Nykanen D, Freedom RM, Benson L (1998) Complications associated with pediatric cardiac catheterization. J Am Coll Cardiol 32:1243–1244
27.
Zurück zum Zitat Wellens HJ (2005) When to perform catheter ablation in asymptomatic patients with a Wolff-Parkinson-White electrocardiogram. Circulation 112:2201–2207CrossRefPubMed Wellens HJ (2005) When to perform catheter ablation in asymptomatic patients with a Wolff-Parkinson-White electrocardiogram. Circulation 112:2201–2207CrossRefPubMed
28.
Zurück zum Zitat Wellens HJJ, Brugada P, Bär FW (1987) Indications for use intracardiac electrocardiographic studies for the diagnosis of site of origin and mechanism of tachycardias. Circulation 75(Suppl II):III110–III115PubMed Wellens HJJ, Brugada P, Bär FW (1987) Indications for use intracardiac electrocardiographic studies for the diagnosis of site of origin and mechanism of tachycardias. Circulation 75(Suppl II):III110–III115PubMed
Metadaten
Titel
Impact of Transesophageal Electrophysiologic Study to Elucidate the Mechanism of Arrhythmia on Children With Supraventricular Tachycardia and No Preexcitation
verfasst von
Béatrice Brembilla-Perrot
A. Moulin-Zinsch
J. M. Sellal
J. Schwartz
A. Olivier
P. Y. Zinzius
C. De Chillou
D. Beurrier
M. Rodermann
G. Goudote
H. Al Amoura
A. Terrier de la Chaise
J. Lemoine
J. Rizk
J. P. Lethor
J. L. Anne Tisserand
S. Taïhi
F. Marçon
Publikationsdatum
01.10.2013
Verlag
Springer US
Erschienen in
Pediatric Cardiology / Ausgabe 7/2013
Print ISSN: 0172-0643
Elektronische ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-013-0703-7

Weitere Artikel der Ausgabe 7/2013

Pediatric Cardiology 7/2013 Zur Ausgabe

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.