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ABSTRACT: Supraventrikuläre
Tachykardien sind die häufigsten
symptomatischen Tachyarrhythmien
im Säuglings- und
Kindesalter. Die klinische Symptomatik
ist neben der zugrunde liegenden
Rhythmusstörung abhängig
vom Lebensalter des Kindes
sowie von der vorliegenden kardialen
Anatomie. Adenosin ist inzwischen
Mittel der ersten Wahl in der
Behandlung akuter Episoden atrioventrikulärer
Reentry-Tachykardien
in jeder Altersstufe. Die Langzeit-Behandlung von atrioventrikulären
Reentry-Tachykardien im
Säuglings- und Kindesalter richtet
sich nach dem Lebensalter sowie
der Klinik des Patienten. Bei Neugeborenen
und Säuglingen tritt bei
der Mehrzahl der Patienten eine
Spontanresolution der Tachykardien
mit dem Ende des ersten Lebensjahres
ein. Aus diesem Grund
ist in dieser Altersklasse eine pharmakologische
Therapie zu empfehlen.
Im Gegensatz dazu ist die Aussicht
auf ein spontanes Sistieren
der Tachykardieneigung bei Schulkindern
und Adoleszenten äußerst
gering. Daher stellt in dieser Altersgruppe
die Katheterablation des
anatomischen Substrats der Tachykardien
die Therapie der 1.Wahl
gegenüber einer meist mehrjährigen
medikamentösen Therapie dar.
Das Verfahren ist im Kindesalter
sehr effektiv und sicher, Komplikationen
sind selten.
Supraventricular
tachycardias are the most frequent
forms of symptomatic tachyarrhythmias
in infants, children and
adolescents. Clinical symptoms depend
on age and underlying cardiac
anatomy. Adenosine has evolved
as the drug of choice for all age
groups for termination of atrioventricular
reentrant tachycardias.
Long-term management of supraventricular
tachycardia in infancy
and childhood is age-dependent. In
newborn babies and infants, pharmacological
therapy is advised due
to the high spontaneous cessation
rate of those tachycardias at the
end of the first year of life. In contrast
to this, probability of spontaneous
tachycardia resolution in
children and adolescents is very
low. Therefore, catheter ablation of
the anatomical substrate of the
tachycardia is the treatment of
choice in contrast to a long-lasting
antiarrhythmic therapy in this age
group. Catheter ablation in children
with a structurally normal
heart is highly effective with a very
low complication rate.
Somnologie - Schlafforschung und Schlafmedizin 04/2012; 11(1):9-15.
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ABSTRACT: Supraventrikuläre Tachykardien sind die häufigste symptomatische Tachyarrhythmie im Säuglings- und Kindesalter. Die klinische
Symptomatik ist neben der zugrundeliegenden Rhythmusstörung abhängig vom Lebensalter des Kindes sowie von der vorliegenden
kardialen Anatomie. Neugeborene und Säuglinge mit paroxysmalen atrioventrikulären Reentry-Tachykardien entwickeln aufgrund
der hohen Kammerfrequenzen rasch Zeichen der Herzinsuffizienz. Ältere Kinder und Jugendliche hingegen klagen häufig über Palpitationen.
Kinder mit chronisch-permanenten Tachykardien wie der ektopen Vorhoftachykardie und der permanenten Form der junktionalen
Reentry-Tachykardie entwickeln zu einem beträchtlichen Anteil eine sekundäre Form der dilatativen Kardiomyopathie, die sogenannte
„Tachymyopathie”.¶ Adenosin ist inzwischen Mittel der ersten Wahl in der Behandlung akuter Episoden atrioventrikulärer Reentry-Tachykardien
in jeder Altersstufe. Zusätzlich erlaubt die Substanz im Zweifel die Diagnose primärer atrialer Tachykardien. Die Langzeit-Behandlung
von atrioventrikulären Reentry-Tachykardien im Säuglings- und Kindesalter richtet sich nach dem Lebensalter sowie der Klinik
des Patienten. Bei Neugeborenen und Säuglingen tritt bei der Mehrzahl der Patienten eine Spontanresolution der Tachykardien
mit dem Ende des ersten Lebensjahres ein. Aus diesem Grund ist in dieser Altersklasse eine pharmakologische Therapie zu empfehlen.
Im Gegensatz dazu ist die Aussicht auf ein spontanes Sistieren der Tachykardieneigung bei Kindern >1 Jahr äußerst gering.
Daher stellt die Hochfrequenzstromablation des anatomischen Substrats der Tachykardien eine sinnvolle Alternative zur meist
mehrjährigen medikamentösen Therapie dar. Die Ergebnisse der Ablationsbehandlung bei Kindern und Jugendlichen mit einem strukturell
normalen Herz sind mit denen erwachsener Patienten vergleichbar. Bei Patienten mit einem angeborenen Herzfehler und supraventrikulären
Tachykardien auf der Grundlage einer akzessorischen atrioventrikulären Leitungsbahn bzw. basierend auf einem AV-Knoten-Reentry-Mechanismus
sollte die Hochfrequenzstromablation des anatomischen Substrats der Tachykardien bereits im Rahmen der präoperativen Herzkatheteruntersuchung
erwogen werden.¶ Nach Korrekturoperation eines angeborenen Herzfehlers sind atriale Reentry-Tachykardien als signifikanter
Risikofaktor für eine erhöhte spät-postoperative Morbidität und auch Letalität identifiziert worden. Eine pharmakologische
Behandlung ist hier häufig nicht ausreichend wirksam, bei einem Teil der Patienten wird eine gleichzeitig bestehende Sinusknotendysfunktion
erheblich verstärkt. Die Ablationsbehandlung mit konventionellem endokardialem Mapping mittels multipolarer Elektrodenkatheter
mit dem Ziel der Lokalisierung der kritischen Zone des Reentry-Circuits ist mit einer zur Zeit nicht zufriedenstellenden Erfolgsrate
sowie einer beträchtlichen Rezidivrate belastet. Innerhalb der nächsten Jahre ist es durch den Einsatz moderner Mappingverfahren
wie dem elektroanatomischen Mapping sowie dem Non-Contact Mapping zu erwarten, dass die Ergebnisse der Ablationstherapie von
atrialen Reentry-Tachykardien bei jungen Patienten nach Korrekturoperation angeborener Herzfehler erheblich verbessert werden
können.
Supraventricular tachycardias are the most frequent forms of symptomatic tachyarrhythmias in infants, children and adolescents.
Clinical symptoms depend on age and underlying cardiac anatomy. Newborn babies and infants with paroxysmal atrioventricular
reentrant tachycardias usually present with signs of congestive heart failure due to rapid heart rate. In older children and
adolescents, palpitations are the leading symptom. Patients with chronic-permanent tachycardias (i.e., atrial ectopic tachycardia,
permanent form of junctional reciprocating tachycardia) often develop a secondary form of dilated cardiomyopathy, the so-called
„tachymyopathy”.¶ Adenosine has evolved as the drug of choice in any age group for the termination of atrioventricular reentrant
tachycardia of any origin. In addition, it serves as a diagnostic tool in primary atrial tachycardias. Long-term management
of atrioventricular reentrant tachycardia in infancy and childhood is age dependent. In newborn babies and infants, pharmacological
therapy is advised due to the high spontaneous cessation rate of those tachycardias at the end of the first year of life.
In contrast to this, the probability of spontaneous cessation of tachycardia in children >1 year of age is very low. Therefore,
radiofrequency catheter ablation of the anatomical substrate of the tachycardia is a rational alternative to long-lasting
antiarrhythmic therapy. Results in children with a structurally normal heart are comparable to those achieved in adults. In
patients with congenital heart disease and supraventricular tachycardias, catheter ablation during preoperative cardiac catheterization
is recommended.¶ Atrial reentrant tachycardias have been identified as one major risk factor for late postoperative morbidity
and mortality in young patients. Pharmacological therapy is often not sufficient to control the tachycardia. In addition,
underlying sinus node dysfunction may be aggravated in a considerable portion of the patients affected. Catheter ablation
based on conventional endocardial mapping techniques by multipolar electrode catheters with the aim of identifying the critical
region of the reentrant circuit is associated with an impaired success rate and a considerable recurrence rate. It may be
assumed that, using the modern mapping techniques currently available (electroanatomical mapping and non-contact mapping),
results of radiofrequency catheter ablation of atrial reentrant tachycardias after surgical correction of congenital heart
disease will be significantly improved within the next few years.
Schlüsselwörter Supraventrikuläre Tachykardien – Säuglinge – Kinder – pharmakologische Therapie –¶endokardiales Mapping –¶HochfrequenzstromablationKey words Supraventricular tachycardia – infancy – childhood – pharmacological therapy – endocardial mapping – radiofrequency
catheter ablation
Zeitschrift für Kardiologie 04/2012; 89(6):546-558. · 0.97 Impact Factor
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ABSTRACT: Hintergrund: AV-Knoten-Reentry-Tachykardien stellen die zweithäufigste Form supraventrikulärer Tachykardien im Kindesalter dar.¶ Patienten und Methoden: Bei 41 jungen Patienten mit einem mittleren Alter von 9,6 (3,7–16) Jahren wurde aufgrund medikamentös refraktärer AV-Knoten-Reentry-Tachykardien
(n=38) bzw. rezidivierender Synkopen (n=3) eine elektrophysiologische Untersuchung durchgeführt. Hier konnte bei allen Patienten
durch programmierte Vorhofstimulation eine duale AV-Knoten-Physiologie nachgewiesen und die typische Tachykardie (slow-fast-Typ,
Kammerfrequenz im Mittel 220/min) induziert werden. Ein steuerbarer 7 F Ablationskatheter wurde zunächst in der inferoparaseptalen
Region nahe am Ostium des Koronarvenensinus am Trikuspidalklappenanulus plaziert. Ziel war die Registrierung eines späten
und fraktionierten lokalen atrialen Elektrogramms während Sinusrhythmus. Von dieser Stelle ausgehend wurde Hochfrequenzstrom
(500 kHz) mit der Zieltemperatur von 70°C zur Ablation des langsam leitenden Schenkels appliziert. Sofern während der Energieabgabe
ein langsam beschleunigter junktionaler Rhythmus (<120/min) auftrat, wurde die programmierte Vorhofstimulation wiederholt.
Ansonsten wurde schrittweise erneut Energie bis in eine septale Position am Trikuspidalklappenanulus appliziert. Als erfolgreiche
Ablation des langsam leitenden Schenkels wurde der fehlende Nachweis der dualen AV-Knoten-Physiologie definiert, als Modulation
des langsam leitenden Schenkels der Nachweis von maximal einem atrialen Echoimpuls.¶ Ergebnisse: Durch 1-19 (Median 6) Energieabgaben konnte bei 35/41 Patienten der langsam leitende Schenkel abladiert werden, bei den übrigen
6 Kindern gelang eine Modulation. Komplikationen wie ein höhergradiger AV-Block wurden nicht beobachtet. Während der Nachbeobachtung
(im Mittel 4,1 Jahre) trat bei 2 Kindern erneut eine supraventrikuläre Tachykardie auf.¶ Schlussfolgerung: Die selektive Hochfrequenzstromablation/-modulation ist auch bei jungen Patienten mit AV-Knoten-Reentry-Tachykardien eine
sichere und kurative Therapie.
Background: Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common forms of supraventricular tachycardia in the
pediatric population.¶ Patients and methods: 41 children with a mean age of 9.6 (3.7–16) years with recurrent atrioventricular nodal reentrant tachycardia (AVNRT) refractory
to medical treatment (n=38) and recurrent syncope (n=3) underwent electrophysiologic (EP) study. In all patients dual AV-nodal
physiology could be demonstrated during EP study and typical form of AVNRT (mean heart rate 220/min) could be induced by programmed
atrial stimulation. A steerable 7 F ablation catheter was placed at the inferoparaseptal region of the tricupid valve annulus
close to the orifice of the coronary sinus with the intention to record a late fractionated local atrial electrogram during
sinus rhythm. Starting at this point radiofrequency current (500 kHz) with a target temperature of 70°C was delivered with
the intention to ablate the slow pathway. If a slowly accelerated junctional rhythm (<120/min) occurred during energy discharge,
programmed atrial stimulation was repeated. Otherwise radiofrequency current was delivered step by step up to a septal position
next to the tricuspid valve annulus. Slow pathway ablation was defined as lack of evidence of dual AV nodal pathways during
repeated atrial stimulation. Slow pathway modulation was defined as maximal one atrial echoimpulse after ablation.¶ Results: The number of energy applications ranged from 1–19 (median 6). In 35/41 patients slow pathway ablation could be achieved;
in six patients the slow pathway was modulated. In none of the patients permanent high grade AV block was observed. During
follow-up (mean 4.1 years) two patients had a recurrent episode of AVNRT after slow pathway modulation. All other patients
are still free of AVNRT without medical treatment.¶ Conclusion: Selective radiofrequency current ablation/modulation of the slow pathway is a safe and curative treatment of AVNRT in young
patients.
Schlüsselwörter AV-Knoten-¶Reentry-Tachykardie –¶Hochfreqenzstromablation –¶KindesalterKey words Atrioventricular nodal¶reentrant tachycardia –¶supraventricular tachycardia –¶radiofrequency catheter ablation –¶children
Zeitschrift für Kardiologie 04/2012; 89(6):538-545. · 0.97 Impact Factor
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Clinical Research in Cardiology 09/2011; 100(12):1123-7. · 2.95 Impact Factor
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Heart (British Cardiac Society) 01/2007; 92(12):1723. · 4.22 Impact Factor
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Clinical Research in Cardiology 01/2007; 95(12):668-70. · 2.95 Impact Factor
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ABSTRACT: In infants and small children, ICD implantation is a challenge due to technical limitations and a significant number of complications. This report describes ICD implantation in a 6-month-old infant (body weight 5.5 kg). A completely extracardiac defibrillation system was implanted using a transvenous lead subcutaneously in the back below the left scapula as the defibrillation electrode and an active-can device in the right upper abdomen. Defibrillation threshold of implantation was < or =10 J. During the follow-up of 3 months, 8 adequate ICD discharges were noted. The technique described seems feasible to facilitate ICD implantation in small infants.
Zeitschrift für Kardiologie 07/2005; 94(6):415-8. · 0.97 Impact Factor
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ABSTRACT: Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a rare, but important cause for sudden death in adolescents and young adults. Part of the patients affected show the pattern of autosomal-dominant inheritance. Two pediatric patients with ARVD/C are presented who may reflect the spectrum of clinical presentation of ARVD/C in childhood resulting in difficulties or even delay to establish the correct diagnosis. One patient with a sporadic form of ARVD/C presented with a syncope and spontaneous as well as inducible ventricular tachycardia. On the ECG, an epsilon wave could be identified. An automatic cardioverter defibrillator was implanted. The second patient had a familiar form of ARVD/C with no symptoms. There was a history of frequent sudden deaths in this family. Biopsies of the right ventricular myocardium showed fibrosis with deposition of fatty tissue. There was clear evidence of ARVD/C in the necropsy of the patient's aunt. Therapy with propanolol was started in this patient.
Zeitschrift für Kardiologie 06/2003; 92(5):418-24. · 0.97 Impact Factor
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ABSTRACT: The purpose of the present study was to determine the role of a novel, noncontact mapping system for assessing a variety of atrial reentrant tachycardias (ART) in patients after the surgical correction of congenital heart disease.
In 14 patients, an electrophysiological study using the Ensite 3000 system was performed to assess ARTs resistant to medical treatment. Sixteen different forms of ART were inducible in the 14 patients studied. The reentrant circuit of all ARTs could be characterized and localized with respect to anatomic landmarks such as atriotomy scars, intraatrial patches/baffles, and cardiac structures. In 15 of the 16 ARTs (in 13 of the 14 patients), a target area of the reentrant circuit for radiofrequency current application (ie, an area of conduction between 2 anatomical obstacles such as surgical barriers and cardiac structures of electrical isolation) could be localized within the systemic venous atrium. Nine patients exhibited macroreentry, and 4 showed microreentry. In 12 patients, ART could be terminated by creating linear radiofrequency current lesions (75 degrees C, 180 to 390 s). Completeness of linear lesions after radiofrequency current delivery was proven by analyzing color-coded isopotential maps of atrial activation while applying atrial pacing techniques. The mean duration of the procedures was 286 minutes (range, 130 to 435 minutes); fluoroscopy time ranged from 7 to 33.8 minutes (mean, 17.4 minutes).
In patients with ART after the surgical correction of congenital heart disease, the use of the noncontact mapping system allows for characterization of the tachycardia and guidance for effective radiofrequency current delivery.
Circulation 06/2001; 103(18):2266-71. · 14.74 Impact Factor
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ABSTRACT: Atrioventricular nodal reentrant tachycardia was proven during electrophysiologic study in 41 children, aged from 3.7 to 16 years, who were referred for catheter ablation of symptomatic supraventricular tachycardia. Using an abbreviated combined anatomical and electrogram-guided approach for selective ablation of the slow pathway, a steerable ablation catheter was placed at the inferior region of the vestibule of the tricuspid valve close to the orifice of the coronary sinus, with the intention of recording a multicomponent local atrial electrogramm during sinus rhythm. If application of radiofrequency current of 500 kHz at 70 degrees C at this site did not result in a slowly accelerated junctional rhythm, at a rate of less than 120 beats per minute, the catheter was stepwise advanced up to a position midway towards the apex of the triangle of Koch for additional applications of energy. Ablation was achieved in 35 of the patients. In 6 patients, the slow pathway was modulated such that the tachycardia could no longer be induced. The number of applications of energy ranged from 1 to 19, with a median of 6 applications. The mean period of fluoroscopy was reduced to 15.6 (4.3 to 39.8) minutes, while the overall duration of the catheterization procedures ranged from 88 to 280 (mean 173.2) minutes. In none of the patients did we observe permanent high grade atrioventricular block. During follow-up over a mean of 4.1 years, two patients had recurrence of tachycardia, corresponding to a 95% rate of success in the midterm. We conclude that selective radiofrequency ablation of the slow pathway using the abbreviated anatomical and electrophysiological approach is a safe and curative therapeutic approach in children with atrioventricular nodal reentrant tachycardia. Periods required for fluoroscopy can be significantly reduced, and mid-term results are excellent.
Cardiology in the Young 04/2001; 11(2):182-7. · 0.76 Impact Factor
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ABSTRACT: Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common forms of supraventricular tachycardia in the pediatric population.
41 children with a mean age of 9.6 (3.7-16) years with recurrent atrioventricular nodal reentrant tachycardia (AVNRT) refractory to medical treatment (n = 38) and recurrent syncope (n = 3) underwent electrophysiologic (EP) study. In all patients dual AV-nodal physiology could be demonstrated during EP study and typical form of AVNRT (mean heart rate 220/min) could be induced by programmed atrial stimulation. A steerable 7 F ablation catheter was placed at the inferoparaseptal region of the tricuspid valve annulus close to the orifice of the coronary sinus with the intention to record a late fractionated local atrial electrogram during sinus rhythm. Starting at this point radiofrequency current (500 kHz) with a target temperature of 70 degrees C was delivered with the intention to ablate the slow pathway. If a slowly accelerated junctional rhythm (< 120/min) occurred during energy discharge, programmed atrial stimulation was repeated. Otherwise radiofrequency current was delivered step by step up to a septal position next to the tricuspid valve annulus. Slow pathway ablation was defined as lack of evidence of dual AV nodal pathways during repeated atrial stimulation. Slow pathway modulation was defined as maximal one atrial echoimpulse after ablation.
The number of energy applications ranged from 1-19 (median 6). In 35/41 patients slow pathway ablation could be achieved; in six patients the slow pathway was modulated. In none of the patients permanent high grade AV block was observed. During follow-up (mean 4.1 years) two patients had a recurrent episode of AVNRT after slow pathway modulation. All other patients are still free of AVNRT without medical treatment.
Selective radiofrequency current ablation/modulation of the slow pathway is a safe and curative treatment of AVNRT in young patients.
Zeitschrift für Kardiologie 06/2000; 89(6):538-45. · 0.97 Impact Factor
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ABSTRACT: Supraventricular tachycardias are the most frequent forms of symptomatic tachyarrhythmias in infants, children and adolescents. Clinical symptoms depend on age and underlying cardiac anatomy. Newborn babies and infants with paroxysmal atrioventricular reentrant tachycardias usually present with signs of congestive heart failure due to rapid heart rate. In older children and adolescents, palpitations are the leading symptom. Patients with chronic-permanent tachycardias (i.e., atrial ectopic tachycardia, permanent form of junctional reciprocating tachycardia) often develop a secondary form of dilated cardiomyopathy, the so-called "tachymyopathy". Adenosine has evolved as the drug of choice in any age group for the termination of atrioventricular reentrant tachycardia of any origin. In addition, it serves as a diagnostic tool in primary atrial tachycardias. Long-term management of atrioventricular reentrant tachycardia in infancy and childhood is age dependent. In newborn babies and infants, pharmacological therapy is advised due to the high spontaneous cessation rate of those tachycardias at the end of the first year of life. In contrast to this, the probability of spontaneous cessation of tachycardia in children > 1 year of age is very low. Therefore, radiofrequency catheter ablation of the anatomical substrate of the tachycardia is a rational alternative to long-lasting antiarrhythmic therapy. Results in children with a structurally normal heart are comparable to those achieved in adults. In patients with congenital heart disease and supraventricular tachycardias, catheter ablation during preoperative cardiac catheterization is recommended. Atrial reentrant tachycardias have been identified as one major risk factor for late postoperative morbidity and mortality in young patients. Pharmacological therapy is often not sufficient to control the tachycardia. In addition, underlying sinus node dysfunction may be aggravated in a considerable portion of the patients affected. Catheter ablation based on conventional endocardial mapping techniques by multipolar electrode catheters with the aim of identifying the critical region of the reentrant circuit is associated with an impaired success rate and a considerable recurrence rate. It may be assumed that, using the modern mapping techniques currently available (electroanatomical mapping and non-contact mapping), results of radiofrequency catheter ablation of atrial reentrant tachycardias after surgical correction of congenital heart disease will be significantly improved within the next few years.
Zeitschrift für Kardiologie 06/2000; 89(6):546-58. · 0.97 Impact Factor
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ABSTRACT: Systemic Lupus erythematosus (SLE) is a chronic inflammatory disease, caused by a fault of the immune regulation. The etiology of the SLE is still unknown, a possible virus infection is discussed. Libman Sacks endokarditis is the most important cardiac manifestation of this illness. Diagnosis, therapy and clinical course of a 7 years old so far healthy girl, which suffered from an acute Libman-Sacks-Endocarditis, are presented.
Klinische Pädiatrie 214(2):93-6. · 1.77 Impact Factor
