Download non-fluoroscopic ablation of wpw in a neonate with

NON-FLUOROSCOPIC ABLATION OF WPW IN A NEONATE WITH
PULMONARY ATRESIA AND INTACT VENTRICULAR SEPTUM
1. John M. Clark, MD, 2. Amee M. Bigelow, MD 1. Akron Children's Hospital, The Heart Center,
Akron, OH, USA 2. Akron Children's Hospital, Department of Pediatrics, Akron, OH, USA
Purpose: Catheter ablation without fluoroscopy has become routine at many institutions. The benefits
to the patient and staff have been well described. However, some challenges still exist including small
patient size and significant congenital heart disease. We report a case of a neonate with complex
congenital heart disease, WPW and SVT who underwent catheter ablation without fluoroscopy.
Method: We report a 9-day old, 3.6kg female with pulmonary atresia, intact ventricular septum and
coronary sinusoids with WPW. A diagnostic cath showed RV dependent coronary circulation, so no
attempt at pulmonary valvuloplasty was made. In the post-catheterization period, she was noted to have
recurrent SVT at 340bpm. Due to the need for a surgical shunt, it was decided to attempt catheter
ablation prior to surgery.
Results: An EP study was performed under general anesthesia. The EnSite Velocity System was used
for catheter guidance (St. Jude Medical, St. Paul, MN). Cutaneous patches were modified to fit the
infant’s torso. A decapolar catheter was placed in the esophagus for atrial pacing. A 6F sheath was
inserted into the left femoral vein. A 5F Marinr SCXS RF ablation catheter was advanced to the right
atrium. Geometry was created with RF catheter. During SVT, the earliest atrial activation was just
anterior to the CS os. RF energy was delivered in this area for 30seconds and there was loss of AP
conduction at 4 seconds. The PR interval was stable. Three additional RF lesions were delivered for
30seconds. Fluoroscopy was available, but not needed. The total procedure time was 112minutes. There
were no complications. A central shunt was successfully placed the following day.
Conclusion: Catheter ablation without fluoroscopy can be challenging in the smallest patients and
patients with congenital heart disease. However, with careful planning it may, in some cases, remain
feasible.