A Case of Congenital Junctional Ectopic Tachycardia: Prenatal Diagnosis and Successful Radiofrequency Catheter Ablation in Infancy

Abstract

It is difficult to make a definitive diagnosis of congenital junctional ectopic tachycardia (JET) in utero. We report a case in which congenial JET was suspected by fetal M-mode echocardiography. Fetal M-mode tracing of the atria and ventricle clearly showed a gradual acceleration of ventricular activity at the beginning of tachycardia, the warming-up sign of ectopic tachycardia, which was followed by simultaneous contractions of atrium and ventricle. This report also describes successful emergent radiofrequency catheter ablation of congenital JET in infancy with preservation of normal AV nodal conduction for this patient.

Efficacy of a pure Ikr blockade with nifekalant in refractory neonatal congenital junctional ectopic tachycardia and careful attention to damaging the atrioventricular conduction during the radiofrequency catheter ablation in infancy

“…The successful ablation sites were the para-Hisian area and midseptal region of the tricuspid annulus, as reported in previous studies 3, 4, 6. There are several ways to resolve JET, such as applying energy at the HBE recording site where the tachycardia rate can be decreased by the mechanical manipulation of the ablation catheter 15 or by the application of energy at the earliest retrograde atrial activation site when ventriculoatrial conduction is present 16 .…”

“…There have been only 5 cases previously reported that have required CA during a patient's infancy 2, 3, 4, 6, 7. All 5 cases were successfully ablated, but the incidence of complications was high.…”

“…However, to the best of our knowledge, this is the first report on the effectiveness of an NIF infusion in infants with congenital JET. Further, there have been only 5 case reports about CA during infancy for JET 2, 3, 4, 6, 7. An accumulation of a case series is needed to improve the outcome of CA during infancy.…”

Pediatric Nonpost-Operative Junctional Ectopic Tachycardia

“…The mechanism of the tachycardia is thought to be abnormal automaticity arising from the region of the atrioventricular junction. Congenital JET presents in infancy and is associated with high morbidity and mortality (1)(2)(3)(4)(5)(6)(7). JET presenting beyond the first 6 months of life has a variable presentation.…”

Transplacental fetal therapy for junctional ectopic tachycardia

“…8 The fetal heart rate showed incessant tachycardia of 160-180 bpm with 1:1 AV relationship. However, they observed with M-mode echocardiography that the normal time delay between peak atrial and peak ventricular contraction shortened progressively with simultaneous atrial and ventricular contraction at the beginning of tachycardia.…”