Electrophysiological studies and radiofrequency catheter ablation in patients with asplenia syndrome

  • Dr Keiko Toyohara, Department of Pediatric Cardiology, Japanese Red Cross Society, Wakayama Medical Center, Japan
  • Dr Yoko Yoshida, Department of Pediatric Cardiology, Japanese Red Cross Society, Wakayama Medical Center, Japan
  • Dr Noriyasu Ozaki, Department of Pediatric Cardiology, Japanese Red Cross Society, Wakayama Medical Center, Japan
  • Dr Hitoo Fukuhara, Department of Pediatric Cardiology, Japanese Red Cross Society, Wakayama Medical Center, Japan
  • Dr Jun Yoshimoto, Department of Pediatric Cardiology, Japanese Red Cross Society, Wakayama Medical Center, Japan
  • Dr Yoshihide Nakamura, Department of Pediatric Cardiology, Japanese Red Cross Society, Wakayama Medical Center, Japan

    • Objectives: We characterized the mechanism of supraventricular tachycardia (SVT) in patients with asplenia syndrome. Patients and methods: We performed electrophysiological studies (EPS) in 17 patients (pre total cavo-pulmonary connection (TCPC) =11, post TCPC=6) who had a history of SVT. Results: The type of SVT was atrioventricular nodal reentrant tachycardia (AVNRT): 5, atrioventricular reciprocating tachycardia (AVRT) involving twin atrioventricular nodes (twin AVNs): 4, atrial tachycardia (AT): 4, AVRT with accessory pathway (WPW): 1, atrial flutter (AFL): 1, and junctional tachycardia (JT): 1. 8/17 had twin atrioventricular nodes (twin AVNs). Five patients had AVRT involving twin AVNs. We could ablate the anterior AVN via the atrium in four cases (fenestrated TCPC 2, pre TCPC 2), but were unable to ablate the posterior AV node via the ventricle in one case (post TCPC). In five cases with AVNRT , we could ablate the posterior AVN in two cases with twin AVNs, ablate slow pathway of the anterior AVN in two cases with one AVN, and could not ablate the posterior AV node in one case (post TCPC). In six pre TCPC cases (AT:4, WPW:1, AFL:1) ablation was successful. JT was documented in one case with twin AVNs after TCPC. We were unable to eliminate the JT. We could ablate the substrates in all pre TCPC cases (11/11), but only 3/6 with post TCPC. Conclusion: EPS are essential for complete arrhythmic evaluation before TCPC. After TCPC, it is difficult to manipulate catheters, but it is still possible to ablate the substrates in some patients.