The aim of this study was to describe our experience and outcome of ablation therapy for arrhythmias in pediatrics at a tertiary care center.

Data was collected retrospectively from the hospital medical records. All pediatrics presenting to AUBMC between 2000 and 2020 who underwent cardiac ablation were included. The data collected included type of arrhythmia, ablation technique, age and weight at ablation, procedure complications, medications used, and outcome assessment.

We had 67 patients who underwent cardiac ablation. Of those, 60% were males with a mean age of 15 years. Structural heart disease was present in 6% of patients. Wolff-Parkinson-White syndrome (WPW) was most prevalent at 31%, followed by atrioventricular nodal reentrant tachycardia (AVNRT) at 24%, atrioventricular reentrant tachycardia (AVRT) at 16%, ventricular tachycardia (VT) at 10%, atrial fibrillation (AF) at 3%, and atrial tachycardia (AT) at 1%. The remaining 15% of patients presented with less common types of arrhythmias, including other supraventricular tachycardias (SVTs), retrograde dual atrioventricular nodal reentry, and premature ventricular contractions (PVC). Antiarrhythmic medications were started before the procedure in 59% of our population. Medication regimens postablation included beta-blockers (68%), type 1c antiarrhythmics (25%), calcium channel blockers (3%), ivabradine (2%), and amiodarone (2%). The completed procedures showed a success rate of 93%.

Ablation of arrhythmias in pediatrics is an effective procedure in the treatment of childhood arrhythmias. More studies are needed on cardiac ablation in this age group and those with structural heart disease in the Middle East region.

Catheter ablation has evolved as a safe treatment for atrial flutter (AFL) in patients with pulmonary hypertension (PH), and the recurrence of AFL may accelerate clinical decompensation. The aim of this study was to determine the recurrence rate and risk factors for recurrent AFL in PH patients after ablation.

All PH patients who underwent AFL ablation at Fuwai Hospital between May 2015 and December 2020 were followed up. The recurrence rate and risk factors for recurrence were analyzed.

A total of 68 PH patients (mean age 44.0 ± 13.0 years, 36.8% male) were enrolled. The majority patients diagnosed PH had congenital heart disease-associated PH (63.2%), and 30.9% had idiopathic pulmonary arterial hypertension. At baseline, most patients (80.9%) had only cavotricuspid isthmus (CTI)-related AFL; the occurrence of non-CTI-related AFL among patients was 8.8%, and 10.3% of the patients had both types of AFL. During a median follow-up of 17.5 months, 22 patients developed at least one recurrent AFL episode (AFL-free survival: 76.5% at 1 year). The immediate success of ablation (HR 0.061, 95% CI 0.009 to 0.438; P = 0.005) and the right atrial volume index (RAVi, per 10 ml/m2; HR 1.064, 95% CI 1.011 to 1.120; P = 0.018) were associated with long-term ablation outcomes in PH patients. With 166.64 ml/m2 as a cutoff value, AFL-free survival was significantly greater in patients whose RAVi was < 166.64 ml/m2 (log-rank P = 0.024).

The immediate success of ablation and the RAVi are associated with recurrent AFL. Patients with a RAVi ≥ 166.64 ml/m2 are likely experience recurrence.

Arrhythmias are highly prevalent in adults with congenital heart disease. For the clinician caring for this population, an understanding of pathophysiology, diagnosis, and management of arrhythmia is essential. Herein we review the latest updates in diagnostics and treatment of tachyarrhythmias and bradyarrhythmias, all in the context of congenital anatomy, hemodynamics, and standard invasive palliations for congenital heart disease.

The prevalence of congenital heart disease (CHD) in adult patients has risen with advances in diagnostic and surgical techniques. Surgical modifications and hemodynamic changes increase the susceptibility to arrhythmias, impacting morbidity and mortality rates, with arrhythmias being the leading cause of hospitalizations and sudden deaths. Patients with CHD commonly experience both supraventricular and ventricular arrhythmias, with each CHD type associated with different arrhythmia patterns. Macroreentrant atrial tachycardias, particularly cavotricuspid isthmus-dependent flutter, are frequently reported. Ventricular arrhythmias, including monomorphic ventricular tachycardia, are prevalent, especially in patients with surgical scars. Pharmacological therapy involves antiarrhythmic and anticoagulant drugs, though data are limited with potential adverse effects. Catheter ablation is preferred, demanding meticulous procedural planning due to anatomical complexity and vascular access challenges. Combining imaging techniques with electroanatomic navigation enhances outcomes. However, risk stratification for sudden death remains challenging due to anatomical variability. This article practically reviews the most common tachyarrhythmias, treatment options, and clinical management strategies for these patients.

To investigate the clinical significance of right atrial mapping prior to cavotricuspid isthmus (CTI) ablation in patients with typical atrial flutter (AFL).

Clinical and ablation parameters were retrospectively assessed and compared in patients undergoing CTI ablation with or without a first-step right atrial mapping (FRAM) by using the CARTO 3D mapping system.

CTI block by radiofrequency ablation (RFA) was achieved in all 143 patients. In the FRAM group there was a shorter ablation duration and fluoroscopy exposure compared with the non-FRAM group. CHA₂DS₂-VASc score was associated with higher ablation durations, more ablation applications and increased fluoroscopy exposure. Body mass index (BMI) was associated with longer ablation duration and more ablation applications. Furthermore, patients with reduced left ventricular ejection fraction (LVEF) had longer ablation durations and more fluoroscopy exposure. One patient in the non-FRAM group developed cardiac effusion after ablation. None of the patients had recurrence after 6 months of follow-up.

Patients with high BMI, high CHA₂DS₂-VASc score and reduced LVEF may benefit from the FRAM approach by reducing ablation duration, number of ablation applications and fluoroscopy exposure.

Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.

The adult congenital heart patient population is rapidly growing due to increasing survival rates, and they often face chronic physiologic challenges as sequalae of both their defects and repairs. Among the most common sequalae are arrhythmias. Here we describe intra-atrial reentrant tachycardia (IART), one of the most commonly seen arrhythmias in the adult congenital heart population, and the approaches to successful ablation in adult congenital heart patients.

IART has increasing ablation success rates due to the increasing exposure of electrophysiologists to congenital cases, advances in technology, and the increasing application of both our pediatric congenital knowledge and adult acquired knowledge to the adult congenital population.

IART is a frequently seen arrhythmia in the adult congenital population, and it can have life-threatening consequences in the setting of congenital disease. Ablation techniques and treatment rates have improved over time, despite the challenges these cases present to clinicians; success of the ablation depends on careful, often creative, preplanning, and understanding of the complex individualized anatomy and circuits of the patient.

Palpitations are one of the most common reasons for medical consultation. They tend to worry patients and can affect their quality of life. They are often a symptom associated with cardiac rhythm disorders, although there are other etiologies. For diagnosis, it is essential to be able to reliably correlate the symptoms with an electrocardiographic record allowing the identification or ruling out of a possible rhythm disorder. However, reaching a diagnosis is not always simple, given that they tend to be transitory symptoms and the patient is frequently asymptomatic at the time of assessment. In recent years, electrocardiographic monitoring systems have incorporated many technical improvements that solve several of the 24-h Holter monitor limitations. The objective of this review is to provide an update on the different monitoring methods currently available, remarking their indications and limitations, to help healthcare professionals to appropriately select and use them in the work-up of patients with palpitations.

[Figure: see text].

Mapping and ablation of localized reentry atrial tachycardia (AT) can be challenging, especially in those with varying cycle length (CL).

We attempted to use the traditional maneuver of overdrive pacing to facilitate AT mapping.

Data were collected from 12 patients with localized ATs. All patients had prior cardiac surgery or prior atrial fibrillation ablation. Overdrive pacing mapping (ODPM) was performed to find independent local activity (ILA) and compared with conventional activation mapping (CAM) during ongoing AT to determine its accuracy and efficacy. Patients with macro-reentry AT around the tricuspid or mitral annulus were excluded.

Twelve patients with 14 localized ATs were included. All 14 ATs including 4 (29%) with varying CL successfully completed ODPM and had the ILA, although two ATs terminated during ODP and required repeated mapping. Radiofrequency ablation focused on critical sites with ILA was successful in all 12 patients. Using CAM, however, 6 of 14 ATs (43%) mapping attempts were aborted due to AT termination (2 ATs) or varying CL (4 ATs), and only 5 of 8 (63%) located "critical sites" were ultimately confirmed by entrainment and ablation results. After 25 ± 9 months of follow-up, no patient had AT recurrence.

Our preliminary results demonstrated that ODPM is superior to CAM in ATs that were poorly sustained or with varying CL and is a useful supplement to CAM.

Adult survivors of congenital heart disease (CHD) are at increased risk of arrhythmia. The goal of this review is to outline diagnostic and therapeutic approaches to arrhythmia in adult CHD patients.

Macro-reentrant atrial tachyarrhythmia is the most common arrhythmia encountered in adults with CHD. Approximately 25% of hospitalizations associated with arrhythmia. The risk of ventricular arrhythmia is estimated as high as 25-100 times that for the general population and increased after two decades. Routine ambulatory monitoring is important for arrhythmia risk assessment in adults with CHD. There are limitations, potential adverse effects, and risk of recurrence with antiarrhythmic drugs, catheter ablation, and surgical approaches. Adults with CHD suffer various forms of arrhythmia, are at increased risk of sudden death, and require special consideration for medical and interventional therapy.