Hostname: page-component-76fb5796d-22dnz Total loading time: 0 Render date: 2024-04-26T21:55:05.924Z Has data issue: false hasContentIssue false
  • English
  • Français

Two decades of experience on ablation in children with Ebstein’s anomaly

Part of: Electrophysiology

Published online by Cambridge University Press:  21 June 2021

Tevfik Karagöz ,
İlker Ertuğrul Open the ORCID record for İlker Ertuğrul [Opens in a new window] ,
Ebru Aypar Open the ORCID record for Ebru Aypar [Opens in a new window] ,
Aydın Adıgüzel ,
Hayrettin Hakan Aykan ,
Murat Şahin ,
Işıl Yıldırım Baştuhan ,
Dursun Alehan  and
Alpay Çeliker
Tevfik Karagöz
Affiliation:
Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
İlker Ertuğrul*
Affiliation:
Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
Ebru Aypar
Affiliation:
Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
Aydın Adıgüzel
Affiliation:
Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
Hayrettin Hakan Aykan
Affiliation:
Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
Murat Şahin
Affiliation:
Department of Paediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Centre and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey
Işıl Yıldırım Baştuhan
Affiliation:
Department of Paediatric Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
Dursun Alehan
Affiliation:
Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara, Turkey
Alpay Çeliker
Affiliation:
Department of Paediatric Cardiology, American Hospital, İstanbul, Turkey
*
Author for correspondence: Ilker Ertuğrul, MD, Department of Paediatric Cardiology, Hacettepe Universty Ihsan Dogramacı Children’s Hospital, Ankara 06230, Turkey. Tel: +903123051157. E-mail: ilker.ertugrul@hacettepe.edu.tr
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Accessory pathways are commonly seen due to delamination of tricuspid valve leaflets. In addition to accessory pathways, an enlarged right atrium due to tricuspid regurgitation and incisional scars creates substrates for atrial re-entries and ectopic tachycardia. We sought to describe our experience with catheter ablation in children with Ebstein’s anomaly.

Methods and results:

During the study period, of 89 patients diagnosed with Ebstein’s anomaly, 26 (30.9%) of them who underwent 33 ablation procedures were included in the study. Accessory pathways were observed in the majority of procedures (n = 27), whereas atrial flutter was observed in five, atrioventricular nodal reentrant tachycardia in five, and atrial tachycardia in two procedures. Accessory pathways were commonly localised in the right posteroseptal (n = 10 patients), right posterolateral (n = 14 patients), septal (n = two patients), and left posteroseptal (n = one patient) areas. Multiple accessory pathways and coexistent arrhythmia were observed in six procedures. All ablation attempts related to the accessory pathways were successful, but recurrence was observed in five (19%) of the ablations. Ablation for atrial flutter was performed in five patients; two of them were ablated successfully. One of the atrial tachycardia cases was ablated successfully.

Conclusions:

Ablation in patients with Ebstein’s anomaly is challenging, and due to nature of the disease, it is not a rare occasion in this group of patients. Ablation of accessory pathways has high success, but also relatively high recurrence rates, whereas ablation of atrial arrhythmias has lower success rates, especially in operated patients.

Keywords

Ebstein’s anomalyablationpaediatric
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 3 , March 2022 , pp. 437 - 443
Check for updates
Copyright
© The Author(s), 2021. 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

Attenhofer Jost, CH, Connolly, HM, Dearani, JA, Edwards, WD, Danielson, GK. Ebstein’s anomaly. Circulation 2007; 115: 277–285.CrossRefGoogle ScholarPubMed
Geerdink, LM, Kapusta, L. Dealing with Ebstein’s anomaly. Cardiol Young 2014; 24: 191–200.CrossRefGoogle ScholarPubMed
Attenhofer Jost, CH, Connolly, HM, O’Leary, PW, Warnes, CA, Tajik, AJ, Seward, JB. Left heart lesions in patients with Ebstein anomaly. Mayo Clin Proc 2005; 80: 361–368.CrossRefGoogle ScholarPubMed
Celermajer, DS, Bull, C, Till, JA, et al. Ebstein’s anomaly: presentation and outcome from fetus to adult. J Am Coll Cardiol 1994; 23: 170–176.CrossRefGoogle ScholarPubMed
Philip Saul, J. Special Considerations for Ablation in Pediatric Patients. Saunders, Elsevier, Philadelphia, 2006.Google Scholar
Roten, L, Lukac, P, Groot, NDE, et al. Catheter ablation of arrhythmias in Ebstein’s anomaly: a multicenter study. J Cardiovasc Electrophysiol 2011; 22: 1391–1396.10.1111/j.1540-8167.2011.02161.xCrossRefGoogle ScholarPubMed
Kanter, RJ. Ebstein’s anomaly of the tricuspid valve: a Wolf(f) in sheep’s clothing. J Cardiovasc Electrophysiol 2006; 17: 1337–1339.CrossRefGoogle Scholar
Reich, JD, Auld, D, Hulse, E, Sullivan, K, Campbell, R. The pediatric radiofrequency ablation registry’s experience with Ebstein’s anomaly. Pediatric electrophysiology society. J Cardiovasc Electrophysiol 1998; 9: 1370–1377.CrossRefGoogle ScholarPubMed
Walsh, EP. Ebstein’s anomaly of the tricuspid valve: a natural laboratory for re-entrant tachycardias. JACC Clin Electrophysiol 2018; 4: 1271–1288.10.1016/j.jacep.2018.05.024CrossRefGoogle ScholarPubMed
Hassan, A, Tan, NY, Aung, H, et al. Outcomes of atrial arrhythmia radiofrequency catheter ablation in patients with Ebstein’s anomaly. Europace 2018; 20: 535–540.CrossRefGoogle ScholarPubMed
Orczykowski, M, Derejko, P, Bodalski, R, et al. Radiofrequency catheter ablation of accessory pathways in patients with Ebstein’s anomaly: at 8 years of follow-up. Cardiol J 2017; 24: 1–8.CrossRefGoogle ScholarPubMed
Shiina, A, Seward, JB, Edwards, WD, Hagler, DJ, Tajik, AJ. Two-dimensional echocardiographic spectrum of Ebstein’s anomaly: detailed anatomic assessment. J Am Coll Cardiol 1984; 3: 356–370.CrossRefGoogle ScholarPubMed
Hebe, J. Ebstein’s anomaly in adults. Arrhythmias: diagnosis and therapeutic approach. Thorac Cardiovasc Surg 2000; 48: 214–219.10.1055/s-2000-6897CrossRefGoogle ScholarPubMed
Chang, YM, Wang, JK, Chiu, SN, et al. Clinical spectrum and long-term outcome of Ebstein’s anomaly based on a 26-year experience in an Asian cohort. Eur J Pediatr 2009; 168: 685–690.CrossRefGoogle Scholar
Delhaas, T, Sarvaas, GJ, Rijlaarsdam, ME, et al. A multicenter, long-term study on arrhythmias in children with Ebstein anomaly. Pediatr Cardiol 2010; 31: 229–233.10.1007/s00246-009-9590-3CrossRefGoogle ScholarPubMed
Marcondes, L, Sanders, SP, Del Nido, PJ, Walsh, EP. Examination of pathologic features of the right atrioventricular groove in hearts with Ebstein anomaly and correlation with arrhythmias. Heart Rhythm 2020; 17(7): 1092–1098.10.1016/j.hrthm.2020.01.013CrossRefGoogle Scholar
Lev, M, Gibson, S, Miller, RA. Ebstein’s disease with Wolff-Parkinson-White syndrome; report of a case with a histopathologic study of possible conduction pathways. Am Heart J 1955; 49: 724–741.10.1016/0002-8703(55)90218-0CrossRefGoogle ScholarPubMed
Sacher, F, Wright, M, Tedrow, UB, et al. Wolff-Parkinson-White ablation after a prior failure: a 7-year multicentre experience. Europace 2010; 12: 835–841.CrossRefGoogle ScholarPubMed
Calkins, H, Yong, P, Miller, JM, et al. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation 1999; 99: 262–270.CrossRefGoogle ScholarPubMed
Ueshima, K, Nakamura, Y, Takeno, S, Miyake, T, Takemura, T. Atriofascicular Mahaim with Ebstein anomaly: a case report. J Arrhythm 2017; 33: 508–510.CrossRefGoogle ScholarPubMed
Vukmirovic, M, Peichl, P, Kautzner, J. Catheter ablation of multiple accessory pathways in Ebstein anomaly guided by intracardiac echocardiography. Europace 2016; 18: 339.CrossRefGoogle ScholarPubMed
Wei, W, Zhan, X, Xue, Y, et al. Features of accessory pathways in adult Ebstein’s anomaly. Europace 2014; 16: 1619–1625.10.1093/europace/euu028CrossRefGoogle ScholarPubMed
Gulletta, S, Tsiachris, D, Radinovic, A, et al. Safety and efficacy of open irrigated-tip catheter ablation of Wolff-Parkinson-White syndrome in children and adolescents. Pacing Clin Electrophysiol 2013; 36: 486–490.10.1111/pace.12086CrossRefGoogle ScholarPubMed
Liang, M, Wang, Z, Liang, Y, et al. Different approaches for Catheter ablation of para-Hisian accessory pathways: implications for mapping and ablation. Circ Arrhythm Electrophysiol 2017; 10: e004882.CrossRefGoogle ScholarPubMed
Gaita, F, Haissaguerre, M, Giustetto, C, et al. Safety and efficacy of cryoablation of accessory pathways adjacent to the normal conduction system. J Cardiovasc Electrophysiol 2003; 14: 825–829.10.1046/j.1540-8167.2003.03076.xCrossRefGoogle Scholar
Bar-Cohen, Y, Cecchin, F, Alexander, ME, Berul, CI, Triedman, JK, Walsh, EP. Cryoablation for accessory pathways located near normal conduction tissues or within the coronary venous system in children and young adults. Heart Rhythm 2006; 3: 253–258.CrossRefGoogle ScholarPubMed
Mavroudis, C, Stulak, JM, Ad, N, et al. Prophylactic atrial arrhythmia surgical procedures with congenital heart operations: review and recommendations. Ann Thorac Surg 2015; 99: 352–359.10.1016/j.athoracsur.2014.07.026CrossRefGoogle ScholarPubMed
Anter, E, Tschabrunn, CM, Josephson, ME. High-resolution mapping of scar-related atrial arrhythmias using smaller electrodes with closer interelectrode spacing. Circ Arrhythm Electrophysiol 2015; 8: 537–545.10.1161/CIRCEP.114.002737CrossRefGoogle ScholarPubMed