Fabrizio Drago, Maurizio Bevilacqua, Andrea Mazza*, Massimo Stefano Silvetti, Paolo Versacci, Silvia Anaclerio, Pietro Ragonese.
Bambino Gesu Hospital, Rome, *S. Camillo Hospital, Rome, Italy
|
|
Fourteen children (6 males, 8 females, mean age
60.7±60.6 months, median 48) affected by permanent junctional reciprocating tachycardia
(PJRT) were referred to our Institute between 1987 and 1997. Pharmacological therapy was
used in 12 patients: flecainide and propranolol in 5, amiodarone alone in 4 and in association
with propranolol in 1, propafenone alone in 1 and in association with sotalol in 1.These drugs
were given for a mean period of 62±57.4 months with a complete resolution of the
cardiomyopathy in 7/7. Eight patients (mean age 151±16 months) were treated with
radiofrequency transcatheter ablation (RFTA) after a mean duration of medical treatment of
101.6±56.46 months. The shortest ventriculo-atrial interval during tachycardia, considered
as target for ablation, was recorded in all cases at the coronary sinus ostium (mean value of
surface RP’- local VA -40 msec, range -25/-55). Successful ablation of the anomalous pathway
was obtained at this site in all patients with an average number of 2.5±1.4 of radiofrequency
pulses (mean W 26±3, mean T° 64±5). During the follow-up (mean 23±17 months) 2 patients
with a recurrence of PJRT, 1 month and 8 months after the ablation, were submitted to a
second successful procedure.
In conclusion, PJRT in pediatric patients can be successfully and safely treated with antiarrhythmic
drugs, allowing radiofrequency ablation to be delayed until the children have reached an
adequate growth. In our experience the site of successful ablation was always at the ostium
of coronary sinus.
|
