SUCCESSFUL ABLATION OF CONCEALED ACCESSORY PATHWAY MEDIATED SUPRAVENTRICULAR TACHYCARDIA IN A 5-YEAR-OLD CHILD WITH EBSTEIN ANOMALY/USPJESNA ABLACIJA SKRIVENOG AKCESORNOG PUTA U DJETETA S EBSTEINOVOM ANOMALIJOM I SUPRAVENTRIKULSKOM TAHIKARDIJOM

• Published in: Acta clinica Croatica (Tisak) 2024-03, Vol.63 (1), p.197
• Main Authors: Krmek, Nikola, Jegdic, Vladimir, Rode, Mirta
• Format: Article
• Language: English
• Subjects: Ablation (Surgery); Care and treatment; Complications and side effects; Ebstein's anomaly; Electrocardiogram; Electrocardiography; Evaluation; Health aspects; Patient outcomes; Pediatric cardiology; Risk factors; Supraventricular tachycardia
• ISSN: 0353-9466
• DOI: 10.20471/acc.2024.63.01.24

Here we report a case of a S-year-old boy with Ebstein anomaly and supraventricular tachycardia. He was diagnosed with Ebstein anomaly at the age of 3 months during the workup for afebrile convulsions, and has been followed by a pediatric cardiologist since. Electrocardiography recorded a small Rr pattern in VI on a few occasions, without other abnormalities. At the age of 2.5 years, the first episode of supraventricular tachycardia was recorded and stopped with adenosine. He was started on atenolol and was asymptomatic until a year later when he presented with the second recorded supraventricular tachycardia. He was referred to our institution for an electrophysiology study with ablation. Tachycardia was entrained and all the maneuvers were in accordance with atrioventricular reentry tachycardia. Tricuspid annulus was mapped during tachycardia. The earliest atrial signals appeared in the posteroseptal region of the valve, mechanical blocking of the tachycardia was recorded in that region, and early fractionated signal was present during ventricular retrograde pacing. The pathway was successfully ablated. Basal electrocardiogram was without change after ablation and the patient did not experience recurrence of tachycardia during follow-up. This case shows the efficacy and importance of ablation in Ebstein anomaly, without x-ray or intracardiac echocardiography. Key words: Ebstein anomaly; Tachycardia, supraventricular; Electrophysiology U ovom prikazu opisan je slucaj djecaka u dobi od 5 godina s Ebsteinovom anomalijom i supraventrikulskom tahikardijom. U dobi od 3 mjeseca, tijekom obrade afebrilnih konvulzija, ustanovljena mu je navedena anomalija te se od tada prati kod djecjeg kardiologa. Elektrokardiografski mu je u nekoliko navrata zabiljezen uzorak Rr' u VI, bez drugih abnormalnosti. U dobi od 2,5 godine zabiljezena je prva epizoda supraventrikulske tahikardije koja je prekinuta adenozinom te je djecak od tada na terapiji atenololom. Nije imao tegoba sve do godinu dana kasnije, kada mu je drugi puta zabiljezena supraventrikulska tahikardija, zbog cega je upucen u nasu ustanovu na elektrofiziolosku studiju s ablacijom. Ucinjenim manevrima inducirana je atrioventrikulska kruzna tahikardija. Trikuspidni prsten je mapiran tijekom tahikardije. Najraniji signali pojavili su se u posteroseptalnom podrucju trikuspidne valvule, gdje je takoder zabiljezeno mehanicko prekidanje tahikardije, a rani frakcionirani signal bio je prisutan tijekom ventrikulske retrog