Targeted ablation of an anteroseptal accessory pathway in the noncoronary cusp of the aortic valve can be successfully performed in infants with incessant SVT.
Supports aortic cusp ablation feasibility in select infant SVT; leaves open safety, reproducibility, and need for prospective data.
UNLABELLED: A 4-month-old infant presented with incessant SVT and severe failure to thrive. At EP study, orthodromic-reciprocating tachycardia using an anteroseptal accessory pathway was identified. Detailed mapping on the right atrial septum failed to disclose a distinctly early site of atrial activation or a near-field pathway potential. Mapping in the noncoronary cusp of the aortic valve identified a discrete pathway potential that was successfully targeted for ablation. At 12-month follow-up after the procedure, there had been no recurrence of tachycardia. CONCLUSION: Myocardial fibers above the aortic valve cusps may constitute the atrioventricular bypass connection and can be identified and targeted for successful ablation even in infants.
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Balasundaram et al. (2008) studied this question.
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