Prolonged sinus pauses after the paroxysms of atrial tachycardia in children, to pace or to ablate? Case report

Abstract

Background. The presence of prolonged sinus pauses is quite rare in children and adolescents with structural normal heart. The decision of the optimal therapeutic tactics is always challenging. Case report. The 16-years-old girl addressed with complains of palpitations and dizziness after the palpitations end. A Holter ECG monitoring was performed with the detection of prolonged sinus pauses after the paroxysm of atrial tachycardia. We decided to perform an electrophysiological study to diagnose the tachycardia type. The presence of atrial tachycardia originating from the ostium of the coronary sinus was demonstrated. We decided to manage the tachyarrhythmia with catheter ablation. During the application of the radiofrequency currents, the tachycardia stopped, and the sinus rhythm was restored. The ablation was preferred over medication taking into consideration the potential risk of worsening of the bradycardia by antiarrhythmic therapy. Conclusions. The optimal therapeutic solution in similar pediatric cases should be directed towards the supraventricular tachycardia treatment and not to the bradyarrhythmia. The majority of supraventricular tachycardias could be cured by catheter ablation.