open access

Vol 65, No 8 (2007)
Other
Published online: 2007-08-29
Submitted: 2012-12-28
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Invasive electrophysiology
Atrioventricular nodal and atrioventricular reentrant tachycardia in a patient with Ebsteinanomaly – the role of percutaneous RF ablation, surgery and Amplatzer septal occluder

Maria Miszczak-Knecht, Franciszek Walczak, Katarzyna Bieganowska, Bohdan Maruszewski, Łukasz Szumowski, Maria Zubrzycka, Grażyna Brzezińska-Rajszys, Robert Bodalski, Wanda Kawalec
Kardiol Pol 2007;65(8):1012-1017.

open access

Vol 65, No 8 (2007)
Other
Published online: 2007-08-29
Submitted: 2012-12-28

Abstract

We present a case of a twelve-year-old girl with Ebstein’s anomaly, atrial septal defect and two forms of tachycardia. From the first year the patient suffered from episodes of tachycardia. A few months prior to admission, episodes of palpitations became more frequent, periodically incessant and difficult to interrupt, despite amiodarone treatment. During the tachycardia the patient deteriorated with severe cyanosis, hypotension and often with syncope. During sinus rhythm ECG showed RA enlargement and preexcitation. During the documented tachycardia with rate 160-170/min, the ECG showed right bundle branch block (QRS=160 ms) with right axis deviation. An echocardiogram demonstrated dislodgment of septal tricuspid leaflet 30 mm with a high degree of right ventricle atrialisation, moderate tricuspid insufficiency, and ASD with bidirectional shunt. During the EP study two forms of tachycardia were induced: orthodromic atrioventricular reentrant tachycardia, and atrioventricular nodal reentry tachycardia. Both tachycardias were successfully ablated. Four months later the patient underwent TV replacement with aortic homograft, Glenn anastomosis and ASD closure with fenestration. During the next 18 months, the patient was in better general condition, but still was cyanotic especially during exercise (SAT 76%). An Amplatzer occluder was implanted on the ‘residual’ atrial septal defect. During the 24-month follow-up period, the patients has been in a good general condition, showing good exercise tolerance with no cyanosis or arrhythmia.

Abstract

We present a case of a twelve-year-old girl with Ebstein’s anomaly, atrial septal defect and two forms of tachycardia. From the first year the patient suffered from episodes of tachycardia. A few months prior to admission, episodes of palpitations became more frequent, periodically incessant and difficult to interrupt, despite amiodarone treatment. During the tachycardia the patient deteriorated with severe cyanosis, hypotension and often with syncope. During sinus rhythm ECG showed RA enlargement and preexcitation. During the documented tachycardia with rate 160-170/min, the ECG showed right bundle branch block (QRS=160 ms) with right axis deviation. An echocardiogram demonstrated dislodgment of septal tricuspid leaflet 30 mm with a high degree of right ventricle atrialisation, moderate tricuspid insufficiency, and ASD with bidirectional shunt. During the EP study two forms of tachycardia were induced: orthodromic atrioventricular reentrant tachycardia, and atrioventricular nodal reentry tachycardia. Both tachycardias were successfully ablated. Four months later the patient underwent TV replacement with aortic homograft, Glenn anastomosis and ASD closure with fenestration. During the next 18 months, the patient was in better general condition, but still was cyanotic especially during exercise (SAT 76%). An Amplatzer occluder was implanted on the ‘residual’ atrial septal defect. During the 24-month follow-up period, the patients has been in a good general condition, showing good exercise tolerance with no cyanosis or arrhythmia.
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Keywords

Ebstein’s anomaly; atrioventricular reentrant tachycardia; atrioventricular nodal reentry tachycardia; RF ablation; TV replacement with aortic homograft; Glenn anastomosis and ASD closure; Amplatz occluder

About this article
Title

Invasive electrophysiology
Atrioventricular nodal and atrioventricular reentrant tachycardia in a patient with Ebsteinanomaly – the role of percutaneous RF ablation, surgery and Amplatzer septal occluder

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 65, No 8 (2007)

Pages

1012-1017

Published online

2007-08-29

Bibliographic record

Kardiol Pol 2007;65(8):1012-1017.

Keywords

Ebstein’s anomaly
atrioventricular reentrant tachycardia
atrioventricular nodal reentry tachycardia
RF ablation
TV replacement with aortic homograft
Glenn anastomosis and ASD closure
Amplatz occluder

Authors

Maria Miszczak-Knecht
Franciszek Walczak
Katarzyna Bieganowska
Bohdan Maruszewski
Łukasz Szumowski
Maria Zubrzycka
Grażyna Brzezińska-Rajszys
Robert Bodalski
Wanda Kawalec

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