Hostname: page-component-848d4c4894-jbqgn Total loading time: 0 Render date: 2024-06-21T12:51:14.916Z Has data issue: false hasContentIssue false
  • English
  • Français

Ivabradine as a stabilising anti-arrhythmic agent for multifocal atrial tachycardia

Published online by Cambridge University Press:  10 June 2020

Mitchell I. Cohen Open the ORCID record for Mitchell I. Cohen [Opens in a new window] ,
Jordan A. Cohen ,
Connor Shope ,
Lauren Stollar  and
Lucas Collazo
Mitchell I. Cohen*
Affiliation:
Children’s Heart Center, Inova Children’s Hospital, Fairfax, VA, USA
Jordan A. Cohen
Affiliation:
Miller School of Medicine, University of Miami, Miami, FL, USA
Connor Shope
Affiliation:
Division of Electrophysiology, Abbott Medical, St. Paul, MN, USA
Lauren Stollar
Affiliation:
Children’s Heart Center, Inova Children’s Hospital, Fairfax, VA, USA
Lucas Collazo
Affiliation:
Children’s Heart Center, Inova Children’s Hospital, Fairfax, VA, USA
*
Author for correspondence: M. I. Cohen, MD FACC FHRS, Co-Director of the Heart Center, Inova Children’s Hospital, 3300 Gallows Road, Fairfax, VA22042, USA. Tel: +703-942-8300; Fax: +703-876-8417. E-mail: Mitchell.cohen@inova.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Multifocal atrial tachycardia has certain electrocardiographic similarities to atrial fibrillation. The mechanism of atrial fibrillation is heterogenous but in some cases may arise from a single ectopic driver with fibrillatory conduction to the rest of the atria. This has led to the speculation that multifocal atrial tachycardia may have a similar mechanistic unifocal site that disperses through the atrium in a fibrillatory pattern. Ivabradine has been reported to be efficacious in an adult with paroxysmal atrial fibrillation as well as in children with junctional or ectopic atrial tachycardias. This is the first report of successfully using ivabradine, a novel anti-arrhythmic If blocking agent, to convert multifocal atrial tachycardia in a 5-month-old critically ill infant to a pattern indicating a single ectopic atrial focus. This allowed the patient’s single atrial focus to be ablated with return to sinus rhythm and decannulation from ventriculoarterial extracorporeal membrane oxygenation. This case suggests that multifocal atrial tachycardia may arise from a single automatic focus with downstream fibrillatory conduction to the atria.

Keywords

Ivabradinechaotic atrial tachycardiaablationECMOmultifocal atrial tachycardia
Type
Brief Report
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 899 - 902
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bradley, DJ, Fischbach, PS, Law, IH, Serwer, GA, Dick, M II. The clinical course of multifocal atrial tachycardia in infants and children. J Am Coll Cardiol 2001; 38: 401–408.10.1016/S0735-1097(01)01390-0CrossRefGoogle ScholarPubMed
Baek, SM, Chung, H, Song, MY, Bae, EJ, Kim, GB, Ci, Noh. The complexity of pediatric multifocal atrial tachycardia and its prognostic factors. Korean Circ J 2018; 48: 148–158.10.4070/kcj.2017.0179CrossRefGoogle ScholarPubMed
Dieks, JK, Klehs, S, Muller, MJ, Paul, T, Krause, U.Adjunctive ivabradine in combination with amiodarone: a novel therapy for pediatric congenital junctional ectopic tachycardia. Heart Rhythm 2016; 13: 1297–1302.10.1016/j.hrthm.2016.03.015CrossRefGoogle ScholarPubMed
Ergul, Y, Ozturk, E, Ozgur, S, Ozyurt, A, Cilsal, E, Guzeltas, A.Ivabradine is an effective antiarrhythmic therapy for congenital junctional ectopic tachycardia-induced cardiomyopathy during infancy: case studies. Pacing Clin Electrophysiol 2018; 41: 1372–1377.10.1111/pace.13402CrossRefGoogle ScholarPubMed
Janson, CM, Tan, RB, Iyer, VR, Vogel, RL, Vetter, VL, Shah, MJ.Ivabradine for treatment of tachyarrhythmias in children and young adults. Heart Rhythm Case Rep 2019; 5: 333–337.Google Scholar
Bonnet, D, Berger, F, Jokinen, E, Kantor, PF, Daubeney, PEF.Ivabradine in children with dilated cardiomyopathy and symptomatic chronic heart failure. J Am Coll Cardiol 2017; 70: 1262–1272.10.1016/j.jacc.2017.07.725CrossRefGoogle ScholarPubMed
Bevilacqua, LM, Rhee, EK, Epstein, MR, Triedman, JK.Focal ablation of chaotic atrial rhythm in an infant with cardiomyopathy. J Cardiovasc Electrophysiol 2000; 11: 577–581.10.1111/j.1540-8167.2000.tb00012.xCrossRefGoogle Scholar
Iwasaki, Y, Nishida, K, Kato, T, Nattel, S.Atrial fibrillation pathophysiology implications for management. Circulation 2011; 124: 2264–2274.10.1161/CIRCULATIONAHA.111.019893CrossRefGoogle ScholarPubMed
Mecca, AL, Hongsheng, G, Telfer, A, Olshansky, B.Atrial tachycardia originating from a single site with exit block mimicking atrial fibrillation eliminated with radiofrequency applications. J Cardiovasc Electrophysiol 1998; 9: 1100–1108.10.1111/j.1540-8167.1998.tb00887.xCrossRefGoogle ScholarPubMed
Calo, L, Rebecchi, M, Sciarra, L, et al. Catheter ablation of right atrial ganglionated plexi in patients with vagal paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol 2012; 5: 22–31.10.1161/CIRCEP.111.964262CrossRefGoogle ScholarPubMed