Successful Surgical Treatment of Atrial, Junctional, and Ventricular Tachycardia Unassociated with Accessory Connections in Infants and Children

Five children with severe, life-threatening tachydysrhythmias were treated successfully with surgery. Three had atrial ectopic automatic tachycardia (AET), one had AV junctional (his bundle) automatic ectopic tachycardia (JET), and one had ventricular reentry tachycardia (VT). The mechanism and site of the tachycardia were diagnosed preoperatively using intracardiac electrophysiologic studies (EPS). Medical management with all available drugs failed to control the tachycardia in each patient. The two patients with left atrial AET underwent cryoablation of the focus using cardiopulmonary bypass. The patient with right atrial AET had removal of the anterior one third of the right atrial appendage and cryoablation of the edges. The patient with AV JET first had incision and suture ligation of the bundle of His and implantation of a ventricular pacemaker, but the tachycardia recurred 2 weeks later. Cryoablation of the bundle of His prevented further recurrences. Tachycardia stopped in the patient with VT during incision of a tumor in the apex of the left ventricle. No patient had tachycardia after surgery and none has required medical treatment.