title: Radiofrequency ablation on veno-arterial extracorporeal life support in treatment of very sick infants with incessant tachymyopathy.
abstract: OBJECTIVE
  To evaluate the use of extracorporeal membrane oxygenation (ECMO) in supporting infants who require radiofrequency ablation (RFA) for incessant tachyarrhythmias, with particular emphasis on modifications required to standard ablation techniques.
  
  
  RESULTS
  Three cases of RFA carried out in infancy on ECMO support were reviewed retrospectively. Two infants with permanent junctional reciprocating tachycardia (PJRT) and one with ventricular tachycardia (VT) presented in a low cardiac output state, owing to cardiomyopathy caused by incessant tachycardia. In each case antiarrhythmic drug therapy caused haemodynamic collapse, requiring emergency ECMO support. Drug therapy on ECMO was not successful. In one patient, the tachycardia was controlled on ECMO with antiarrhythmic drugs, but recurred following ECMO decannulation. Each patient had a successful RFA on ECMO support. Power delivery was low during ablation lesions. In the PJRT cases power as low as 3-5 Watts was effective. In the VT ablation, an irrigated tip RFA catheter was required when cooling remained poor even after temporarily stopping ECMO flow.
  
  
  CONCLUSIONS
  Extracorporeal membrane oxygenation provides a haemodynamically stable and safe platform for antiarrhythmic drug therapy and RFA in infants with incessant tachyarrhythmias. Once ECMO has been commenced, if the tachyarrhythmia remains difficult to control with antiarrhythmic drugs, RFA should be strongly considered, to avoid the risk of tachycardia recurrence following ECMO decannulation. Power delivery during ablation lesions may be low because of inadequate cooling of the catheter tip. Reducing or stopping flow in the ECMO circuit may not provide adequate cooling and an irrigated tip catheter may be required.
authors.affiliation: East Midlands Congenital Cardiac Centre, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK.
authors.forename: Suhair O
authors.initials: SO
authors.lastname: Shebani
authors.affiliation: Department of Cardiology, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK Department of Cardiovascular Sciences, University of Leicester, UK NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK.
authors.forename: G Andre
authors.initials: GA
authors.lastname: Ng
authors.affiliation: Department of Cardiology, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Stafford
authors.affiliation: East Midlands Congenital Cardiac Centre, Glenfield Hospital, Groby Rd, Leicester LE3 9QP, UK Department of Paediatric Cardiology, King Abdulaziz Medical City, Jeddah, Saudi Arabia akd11@le.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: Duke
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000379:methods; D003422:Critical Care / Q000379:methods*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Cardiomyopathy; Extracorporeal membrane oxygenation; Incessant tachycardia; Infancy; Radiofrequency ablation; Tachymyopathy