title: Radiofrequency catheter ablation of intractable ventricular tachycardia in an infant following arterial switch operation.
abstract: A full-term male neonate presented with cyanosis upon delivery and was subsequently diagnosed with d-transposition of the great arteries, ventricular septal defect, and restrictive atrial septal defect. Following initiation of intravenous prostaglandins and balloon atrial septostomy, an arterial switch operation was performed on day 3 of life. The postoperative course was complicated by intractable ventricular tachycardia that was refractory to lidocaine, amiodarone, esmolol, fosphenytoin, and mexiletine drug therapy. Ventricular tachycardia was suppressed with overdrive atrial pacing but recurred upon discontinuation. Seven weeks postoperatively, radiofrequency catheter ablation was performed due to hemodynamically compromising persistent ventricular tachycardia refractory to medical therapy. The ventricular tachycardia was localized to the inferior-lateral right ventricular outlet septum. The procedure was successful without complications or recurrence. Antiarrhythmics were discontinued after the ablation procedure. Seven days after the ablation, a different, slower fascicular rhythm was noted to compete with the infant's sinus rhythm. This was consistent with the preablation amiodarone having reached subtherapeutic levels given its very long half-life. The patient was restarted on oral beta blockers and amiodarone. The patient was subsequently discharged home in predominantly sinus rhythm with intermittent fascicular rhythm.
authors: Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA.
authors: John P
authors: JP
authors: Costello
authors: Dingchao
authors: D
authors: He
authors: Elizabeth A
authors: EA
authors: Greene
authors: Charles I
authors: CI
authors: Berul
authors: Jeffrey P
authors: JP
authors: Moak
authors: Dilip S
authors: DS
authors: Nath
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017115:Catheter Ablation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Arterial Switch Operation; Congenital Heart Disease; Radiofrequency Catheter Ablation; Transposition of the Great Arteries; Ventricular Tachycardia