Patients on the ledge; ablation of incessant tachycardia. A single centre registry

Abstract Background Incessant tachycardia was first described by Cassidy (1). in 1924, it is strongly associated with tachycardia induced cardiomyopathy. There is no data about its true incidence however, it seems to be more common during infancy and childhood. Objectives To present 5-year single centre experience in ablating incessant tachycardia in a cohort of pediatric and adult patients. Methods From 2018 to 2023, We reviewed patients presented to our centre with incessant tachycardia, their clinical data, ECGs, imaging modalities, procedures details & outcomes were examined thoroughly. Results Over 5 years, 900 patients were referred to our centre for ablation, among them 25 patients (2.7%) presented with incessant tachycardia. Of them: 10 patients were pediatrics (40%), the youngest was 40 days old, 3.4 Kg, 6 patients were haemdynamically unstable necessitating ventilation& IV supports, 14 patients had impaired EF, with the lowest EF of 20%.(A) Regarding the diagnosis, 14 patients had AT (4 CS ostium, 3 LAA, 2 parahisian, 2 Crista, 1 LSPV, 1 TA, 1RAA), 4 AVRT (2 concealed parahisian accessory pathways & 2 PJRT), 3 VT (2 scar related VT, 1 anterior papillary muscle), 4 AFL (3 CTI flutter & 1 mitral isthmus flutter). All patients were ablated using 3D mapping system except 4 pediatric patients (2 AT from CS, 2 concealed parahisian accessory pathways) due to accesses limitations or unavailability of 3D mapping, single catheter technique was used in one patient weighing 3.4kg with AT from CS (only one venous access accommodating 5F catheter could be obtained)(B), Rt & Lt jugular accesses were used for ablation of RAA AT in a pediatric patient with bilaterally occluded femoral veins.(C) NCC was used as a safe access for ablating parahsisan AT & accessory pathways in our cohort.(D) All patients had successful ablation with full recovery for those with impaired function except 2 patients of scar related VT as their EF was impaired previously. Regarding the complications, one patient had DVT and another patient had retroperitoneal hematoma, both were managed conservatively. Conclusion Incessant tachycardia ablation is quite challenging but carries good results. Careful planning, experienced team & selection of the appropriate approach are the keys for successful safe procedures.