Efficacy of a pure Ikr blockade with nifekalant in refractory neonatal congenital junctional ectopic tachycardia and careful attention to damaging the.

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Presentation transcript:

Efficacy of a pure Ikr blockade with nifekalant in refractory neonatal congenital junctional ectopic tachycardia and careful attention to damaging the atrioventricular conduction during the radiofrequency catheter ablation in infancy Hisaaki Aoki, MD, PhD, Tsugutoshi Suzuki, MD, PhD, Hikoro Matsui, MD, PhD, Satoshi Yasukochi, MD, Hirofumi Saiki, MD, PhD, Hideaki Senzaki, MD, PhD, Yoshihide Nakamura, MD HeartRhythm Case Reports Volume 3, Issue 6, Pages 298-301 (June 2017) DOI: 10.1016/j.hrcr.2017.03.005 Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 1 The effectiveness of nifekalant (NIF) in case 1. The trends, heart rate variability, and electrocardiography results are shown. After the first session of radiofrequency catheter ablation (CA1st), the junctional ectopic tachycardia rate gradually increased with the amiodarone (AMD) and landiolol (LAN) administration. However, it was dramatically controlled after the administration of NIF at a dose of 0.8 mg/kg/h. bpm = beats per minute; VR = ventricular rate. HeartRhythm Case Reports 2017 3, 298-301DOI: (10.1016/j.hrcr.2017.03.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 2 Results of intracardiac electrocardiography and fluoroscopy at the successful ablation sites. ABL = ablation catheter; A-V = atrio-ventricular; HRA = high right atrium; RA = right atrium; RAA = right atrial appendage; RV = right ventricle; Open triangle = atrial electrogram; filled triangle = His bundle electrogram (HBE). A: In case 1, an HBE was recorded from the distal bipolar electrodes, but was unclear when recorded from the unipolar electrodes. The atrial wave was half the amplitude of the ventricular wave and the HBE was small. B: The atrial angiography in case 1. C: The ablation catheter was positioned on the anterior septum of the tricuspid annulus during fluoroscopy in case 1. D–H: Results of intracardiac electrocardiography and fluoroscopy at the ablation site in case 2. D, G: The unsuccessful site where an HBE was recorded from the distal bipolar electrodes. The ablation catheter was positioned on the anterior septum of the tricuspid annulus. The ratio of the atrial and ventricular waves was 1:6, and there was a small HBE. E, H: Successful site where an HBE was not recorded and the atrial wave was equal to the ventricular wave when recorded from the distal bipolar electrodes; the ablation catheter was positioned on the midseptum of the tricuspid annulus, which was lower than and toward the atrial side of the prior unsuccessful site. F: The right atrial angiography and each catheter's position. HeartRhythm Case Reports 2017 3, 298-301DOI: (10.1016/j.hrcr.2017.03.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Figure 3 The effectiveness of nifekalant (NIF) in case 2. The tachycardia occurred after the discontinuation of nifekalant prior to the radiofrequency catheter ablation. After the readministration of nifekalant at a dose of 0.4 mg/kg/h, 2:1 block of the junctional ectopic tachycardia from a ventricular rate of 220 to 110 beats per minute (bpm) was observed. HeartRhythm Case Reports 2017 3, 298-301DOI: (10.1016/j.hrcr.2017.03.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions

Supplementary Figure S1 Transient atrioventricular block during the atrial pacing of 150 ppm. Filled triangles represent atrioventricular block and the open triangle is the timing of termination of energy. HeartRhythm Case Reports 2017 3, 298-301DOI: (10.1016/j.hrcr.2017.03.005) Copyright © 2017 Heart Rhythm Society Terms and Conditions