Radiofrequency catheter ablation of idiopathic left anterior fascicular ventricular tachycardia in children

• Published in: Heart rhythm Vol. 11; no. 11; pp. 1948 - 1956
• Main Authors: Suzuki, Tsugutoshi, MD, PhD, Nakamura, Yoshihide, MD, Yoshida, Shuichiro, MD, Yoshida, Yoko, MD, Nakamura, Kae, MD, Sasaki, Takeshi, MD, Fujino, Mitsuhiro, MD, Kawasaki, Yuki, MD, Ehara, Eiji, MD, Murakami, Yosuke, MD, Shintaku, Haruo, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: Adolescent; Bundle of His - physiopathology; Bundle of His - surgery; Cardiovascular; Catheter Ablation - methods; Child; Child, Preschool; Echocardiography; Electrocardiography; Female; Humans; Idiopathic left ventricular tachycardia; Left anterior fascicular ventricular tachycardia; Pediatric; Postoperative Complications; Radiofrequency catheter ablation; Recurrence; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - surgery; Treatment Outcome; isolated delayed potential; BBB; LPF; IVT; radiofrequency; DP; HV; left posterior fascicle/fascicular; His-ventricular; IDP; idiopathic ventricular tachycardia; bundle branch block; electrocardiogram/electrocardiographic; left anterior fascicle/fascicular; Idiopathic left ventricular tachycardia; ECG; radiofrequency catheter ablation; atrioventricular; LAF; RF; RFCA; ventricular tachycardia; AV; diastolic potential; Left anterior fascicular ventricular tachycardia; Pediatric; VT; Radiofrequency catheter ablation
• ISSN: 1547-5271; 1556-3871
• DOI: 10.1016/j.hrthm.2014.06.024

Background Idiopathic ventricular tachycardia of left anterior fascicular origin (IVT-LAF) is a rare condition, and radiofrequency catheter ablation (RFCA) therapy has not been reported in children. Objective This study aimed to evaluate the procedures and outcomes of RFCA for pediatric IVT-LAF. Methods Pediatric IVT-LAF cases for which RFCA was performed between June 2006 and May 2012 at our hospital were reviewed. Results Of 537 pediatric cases of RFCA, 6 had IVT-LAF; 4 had anterior fascicular involvement only, while 2 had both anterior and posterior fascicular involvement. All 6 of them underwent RFCA at the median age of 8.8 years (range 4.3–14.3 years). RFCA was successful in all patients, but 4 had recurrence and underwent 1–3 additional sessions of RFCA. In a total of 10 RFCA sessions, the overall recurrence rate was 50%. The site of RFCA was determined on the basis of detection of diastolic potential during ventricular tachycardia (7 sessions) or isolated delayed potential during sinus rhythm (1) or by pace mapping (2). During the median follow-up period of 33 months, no further recurrence was reported except for 1 patient, who had a recurrence and was scheduled for additional session at the time of this report. Major complications included 1 case of complete atrioventricular block and 1 case of complete left bundle branch block. Conclusion Despite a high recurrence rate and a few complications, RFCA of the site of isolated delayed potential or diastolic potential, if applied cautiously, is a possible treatment of choice for pediatric IVT-LAF.