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(Circulation. 2002;105:2797.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Incessant Ventricular Tachycardia in an Infant Treated With Transmural Radiofrequency Ablation

Aravinda Thiagalingam, FRACP; David Winlaw, FRACS; Aarti Hejmadi, MB BS; Shingo Kasahara, MD; Sandra Biankin, MB BS; Susan Arbuckle, FRCPA; David Ross, FRACP; K.C. Lau, FRCP; Graham Nunn, FRACS

From Adolph Basser Cardiac Institute, Children’s Hospital at Westmead (D.W., A.H., S.K., S.B., S.A., K.C.L., G.N.) and Department of Cardiology, Westmead Hospital (A.T., D.R.), Westmead, Australia.

Correspondence to Aravinda Thiagalingam, FRACP, Cardiology Department, Westmead Hospital, Darcy Rd, Westmead, NSW 2145, Australia.

A previously healthy, 7-month-old male infant weighing 7 kg presented to our institution with a 2-day history of incessant ventricular tachycardia (VT) unresponsive to defibrillation and medication. Echocardiography demonstrated a structurally normal heart and mild mitral regurgitation.

Percutaneous catheter mapping identified that the VT originated in the posterobasal left ventricle. Two attempts at catheter radiofrequency (RF) ablation using both standard and irrigated-tip catheters resulted in temporary slowing or cessation of VT with prompt recurrence.

A surgical approach using cardiopulmonary bypass was then tried. A yellowish plaque on the epicardial surface was noted over the posterobasal left ventricle (Figure 1). Epicardial mapping with a hand-held probe confirmed that the earliest activity occurred at this site (Figure 2). Tissue specimens demonstrated histiocytoid cardiomyopathy (Figure 3), which is a cardiomyopathy of infancy characterized by intractable tachycardia.

View larger version (105K): [in this window] [in a new window]   Figure 1. Hand-held probe mapping the posterior left ventricle. A yellow plaque on the epicardial surface is visible (arrow).

View larger version (20K): [in this window] [in a new window]   Figure 2. Electrograms during ventricular tachycardia. The signals recorded from the lesion (in blue) precede onset of QRS activation in the surface leads.

View larger version (158K): [in this window] [in a new window]   Figure 3. Masson’s Trichrome stain. Surviving myocardium (m) is seen at the top left corner surrounded by scar (s, green staining) from previous percutaneous ablation. Histiocytoid cells (h) are large cells with granular cytoplasms due to large numbers of mitochondria.

Temperature-controlled transmural RF ablation with a needle electrode to a 3x4-cm region of earliest activity and the visible lesion terminated the VT. The surrounding area was treated by cryoablation and the infant remained free of VT. Worsening of mitral regurgitation ultimately necessitated valve replacement. Subsequent follow-up over 6 months has been uneventful.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Thiagalingam, A. Articles by Nunn, G. Search for Related Content PubMed PubMed Citation Articles by Thiagalingam, A. Articles by Nunn, G. Related Collections Electrophysiology Myocardial cardiomyopathy disease Ablation/ICD/surgery Pediatric and congenital heart disease, including cardiovascular surgery Arrhythmias, clinical electrophysiology, drugs