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Late occurrence of adenosine-sensitive focal junctional tachycardia in complex congenital heart disease

Cited 10 time in Web of Science Cited 14 time in Scopus
Authors
Bae, Eun-Jung; Noh, Chung-Il; Choi, Jung-Yun; Yun, Yong-Soo; Kim, Woong-Han; Lee, Jeong-Ryul; Kim, Yong-Jin
Issue Date
2005-03-04
Publisher
Springer
Citation
J Interv Card Electrophysiol. 2005 Mar;12(2):115-22.
Keywords
Adenosine/diagnostic useAdolescentAdultAnti-Arrhythmia Agents/diagnostic useChi-Square DistributionChildChild, PreschoolElectrocardiographyFemaleFontan ProcedureHeart Defects, Congenital/*complications/physiopathologyHumansInfantMaleTachycardia, Ectopic Junctional/*complications/physiopathologyTachycardia, Supraventricular/*etiology/physiopathology
Abstract
BACKGROUND: Although supraventricular tachycardia in complex congenital heart disease (CHD) has been reported after surgical repair, its exact electrophysiologic identification has been limited to intraatrial reentrant tachycardia (IART). Moreover, junctional tachycardia (JT) has not previously been described as a cause of late postoperative arrhythmia. METHODS AND RESULTS: Since 1993, a total of 12 patients with congenital heart disease presented with paroxysmal focal JT. The patients with only typical immediate postoperative junctional ectopic tachycardia were excluded. Medical records, standard electrocardiography and Holter monitoring were reviewed. An intracardiac electrophysiologic (EP) study was performed in 11 patients. Ten patients were in post-Fontan status (5.7% of total Fontan survivors). Focal JT occurred more frequently in heterotaxy syndrome among the Fontan survivors (7/52 vs. 3/124; P < 0.05). The commonest anatomy of the atrioventricular (AV) junction was complete AV canal in 8 patients. EP characteristics of focal JT were as follows: (1) various tachycardia mechanisms were identified (increased automaticity or a triggered mechanism in 6/11, and focal reentry in 5/11, including one concealed nodofascicular pathway) (2) ventriculoatrial conduction during tachycardia was either dissociation (7/12) or variable (5/12) (3) All JTs were terminated by adenosine. Class III antiarrhythmic agent was effective in 5/6. His bundle ablation was performed in one Fontan patient, who already had pacemaker because of accompanying intractable IART and sinus node dysfunction. CONCLUSION: Focal JT may be a source of late term supraventricular tachycardia in patients with complex CHD. The tachycardia mechanism was either automatic/triggered or reentrant. In all patients, JT was effectively terminated by adenosine.
ISSN
1383-875X (Print)
Language
English
URI
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15744463

http://hdl.handle.net/10371/15303
DOI
https://doi.org/10.1007/s10840-005-6546-2
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College of Medicine/School of Medicine (의과대학/대학원)Thoracic Surgery (흉부외과학전공)Journal Papers (저널논문_흉부외과학전공)
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