Serhat Koca

Electroanatomic Mapping-Guided Radiofrequency Ablation of Adenosine Sensitive Incessant Focal Atrial Tachycardia Originating from the Non-Coronary Aortic Cusp in a Child

Incessant focal atrial tachycardia may be encountered in the pediatric age group although it is rarely seen. Ablation using radiofrequency or cryothermal energy is the preferred method for drug-resistant cases. Recently, 3D electroanatomic mapping systems have been increasingly used for mapping and ablation. In this report, we presented, for the first time, a pediatric case with incessant focal atrial tachycardia originating from the non-coronary aortic sinus and ablated using 3D electroanatomic mapping system.

Transesophageal and invasive electrophysiologic evaluation in children with Wolff-Parkinson-White pattern: KOCA et al .

Risk stratification for Wolff‐Parkinson‐White (WPW) pattern either by noninvasive or invasive tests is important to determine whether an ablation is necessary or not. The aim was to compare noninvasive tests and invasive studies in a pediatric WPW population.

The Classic ‘T on P’ Phenomenon

C ongenital long QT syndrome (LQTS) is a genetic channelopathy with variable penetrance characterised by abnormally prolonged ventricular repolarisation with an increased propensity to syncope and polymorphous ventricular tachycardia, which may lead to ventricular fibrillation and sudden cardiac death. Electrocardiography is the primary important step in the diagnosis of LQTS but electrocardiogram (ECG) findings may be easily ignored. We present an asymptomatic two-month-old infant with peculiar ECG features with ‘T on P’ phenomenon caused by a homozygous mutation in the KCNQ1 gene. Implantable cardioverter-defibrillator implantation is an effective therapy and can apply to small children successfully.

Response to adenosine during narrow QRS tachycardia and sinus rhythm: What is the mechanism?: TOPALOGLU et al.

A 26-year-old woman was brought to the electrophysiology laboratory for ablative treatment of highly symptomatic, frequently recurring, electrocardiography (ECG) documented mid-RP narrow complex tachycardia. She had no structural heart disease. During the clinical narrow QRS tachycardia, intravenous adenosine was applied and the tachycardia immediately stopped (Figure 1).What is themechanism of the tachycardia?

Wide QRS complex supraventricular tachycardia with negative precordial concordance: Electrocardiographic clues for Mahaim pathway with Ebstein anomaly

Ebsteins anomaly is often accompanied by either Wolff-Parkinson-White syndrome or atriofascicular Mahaim. These bypass tracts give rise to antidromic atrioventricular (AV) re-entrant tachycardias, in which the bypass tract serves as the anterograde limb of the circuit and the AV node as the retrograde limb of the reentrant circuit. Since the antidromic AV reentrant tachycardia over a Mahaim fibre has a typically left bundle braunch block (LBBB) morphology, it is easy to make a misdiagnosis of supraventricular tachycardia with functional LBBB or even of ventricular tachycardia particularly in the presence of negative concordance. Some electrocardiographic clues might prevent misdiagnosis of ventricular tachycardia and inadvertent ICD implantation.

Heart rate variability parameters in children with ventricular preexcitation

The autonomic nervous system has a regulatory effect on cardiac electrophysiology and arrhythmogenesis. We aimed to assess cardiac autonomic status using heart rate variability (HRV) parameters in children with ventricular preexcitation.

Third Generation Ventricular Assist Device: Mid‐Term Outcomes of the HeartWare HVAD in Pediatric Patients

The HeartWare HVAD is a small, third generation continuous flow pump that is intracorporeally placed for support of a failing ventricle in adult patients. This device is small in size when compared to other left ventricular assist devices and can therefore be used in smaller sized pediatric patients. We present our initial experience using the HVAD as a bridge to heart transplantation in the pediatric population. We performed a retrospective, single center, nonrandomized review of 17 pediatric patients who underwent HVAD implantation between June 2013 and March 2016. The primary endpoints evaluated in this study were overall survival to heart transplantation, ongoing device support, or death. In this patient cohort, nine (53%) of 17 patients were male. The median age of the patients was 13.4 ± 3.8 (range 5-17) years. The median body surface area was 1.4 ± 0.4(0.7-2) m2 . Etiologies of heart failure requiring HVAD support were dilated cardiomyopathy (n = 8), myocarditis (n = 5) and noncompaction cardiomyopathy (n = 4). The overall mean length of HVAD support was 254 ± 298 (range 2-804) days. A successful outcome (bridge to transplant and ongoing mechanical support) was achieved in 13 patients (76.5%). Of the 13 patients, nine (69.2%) were bridged to heart transplantation and four continue to receive support (30.7%) and are eligible for transplantation. Post-transplant survival has been 100%, with a mean follow-up of 296 ± 264.5 (range 18-785) days. The most common complication was pump thrombosis (23.5%) in follow-up. Four patients (23.5%) experienced no complications. The HVAD continuous flow ventricular assist device can be safely used to bridge pediatric patients to cardiac transplantation. Favorable outcomes of this device are comparable to the adult population. This analysis demonstrated safe and effective implantation of the HVAD System in a child with a BSA of 0.7 m2 .

Management of patients with long QT syndrome

I have read with great interest the case report entitled “Epicardially placed implantable cardioverter-defibrillator for a child with congenital long QT syndrome” by Sugiyama et al. in the latest issue of the journal [1]. The authors well presented a case of long QT syndrome managed using implantation of an epicardial shock electrode and dose titration of beta-blocker therapy. However, some important issues should be mentioned. As compared to beta-blocker therapy with metoprolol, treatment with nadolol has been shown to significantly decrease breakthrough cardiac events in symptomatic patients [2]. Furthermore,

Dynamic T-wave Changes with Hump Appearance from a Higher Intercostal Space in a Short QT Syndrome

S hort QT syndrome (SQTS) is an inherited channelopathy associated with marked shortened QT intervals and sudden cardiac death. It is imperative for physicians to recognise the clinical features of the SQTS in making a timely correct diagnosis; however, the diagnosis of SQTS is further complicated by the presence of an overlapping range of QT intervals between affected cases and apparently healthy subjects. We present a case of SQTS with dynamic T-wave changes and T-wave hump appearance in the higher intercostal recordings, and speculate that these dynamic changes are a surrogate marker of underlying repolarisation abnormality and may help in the diagnosis of SQTS.

Cardiac nodal and cardiac autonomic functions in children with vasovagal syncope

In the present study, cardiac nodal (sinoatrial node and atrioventricular node) and cardiac autonomic functions have been investigated in children with vasovagal syncope (VVS). Thus, the effect of existing autonomic status on the characteristics of cardiac conduction system has been demonstrated in children with VVS. The study included 51 pediatric patients (the mean age was 14.01±2.79 years, range 7 to 18 years; 30 females), who were evaluated for syncope using ECG, Holter monitoring, and echocardiography, all of which showed normal findings. All patients underwent head-up tilt testing (HUTT), and the parameters of heart rate variability (HRV) (SDNN, SDANN, SDANNi, rMSSD, pNN50, HF, LF, VLF) were evaluated with the analysis of 24-hour Holter testing. Corrected sinus node recovery time (CNRT) and Wenckebach point (WP) were measured in all patients using transesophageal atrial stimulation. The patients were divided into groups according to HUTT results and evaluated accordingly. Cardiac nodal functions were normal in all patients. HRV parameters (HF, rMSSD, pNN50) indicating parasympathetic effect were higher in patients with positive HUTT results. CNRT did not differ significantly between patients with positive HUTT results and patients with negative HUTT results. However, WP was found to be higher in patients with positive HUTT results. The studies evaluating the parameters of HRV has demonstrated increased parasympathetic tonus in children with VVS. Impairment in cardiac nodal functions may not be expected in children with VVS. However, these patients may exhibit prolonged WP due to increased autonomic tonus in favor of parasympathetic activity.