gms | German Medical Science

The aim of this study is to evaluate the effectiveness and safety of RFCA of ventricular arrhythmias in children and adolescents without structural heart abnormalities with the origine in LVOT.

Materials and methods: The group consists from 20 patients (8 boys and 12 girls) in the age range from 13 to17 years old with symptomatic ventricular premature ectopic beats or/and ventricular tachycardias. ECG, echocardiography, 24 hour monitoring and surface ECG mapping before and after the procedure were done. The follow-up period was from 3 to 48 months. RFCA of the arrhythmogenic focus in LVOT was performed in all patients. Transaortic access was used for mapping and ablation in LVOT. Activation and pace mapping methods were used. The catheter position during the RF energy applications near the ostium of the coronary arteries (>1.2ñì) was precisely controlled by continuous fluoroscopy and coronarography.

Results: the earliest ventricular activation was found in LVOT and the origin of arrhythmia was found in most of our patients in the region of left sinus of Valsalva 17 pts (85%), only in 3 pts (15%) focus was localized in the right sinus of Valsalva and none in noncoronary sinus. We observed earliest activations in the left and right aortic sinuses – -43-87 ms. Sometimes we registred very early prespike. Pace mapping in this site causes near identical QRS morphology. The RFCA parameters through the aortic valve cusps were with the effective temperature in the range of 50-55 C, total application time range was 0.5-5 min and fluoroscopic time range was 3-120 min. There were no arrhytmia reccurences and complications in this group of patients in 48 months follow-up period. Conclusion: RFCA in sinuses of Valsalva in pediatric patients with ventricular arrhytmias without structural heart deseases is effective and safety procedure.