Successful cryoablation for typical atrial flutter in a toddler with sinus node dysfunction: the youngest case report

We describe the youngest (2.8 years, 9 kg) successful cavotricuspid isthmus (CTI) cryoablation whose medical management was complicated with severe sinus node dysfunction and recurrent atrial flutter despite medical therapy (sotalol).

Two-catheter, zero fluoroscopy electrophysiology study was performed using EnSite Precision^TM mapping system. Cavotricuspid isthmus proved to be ‘in’ circuit with entrainment. Point-by-point 2 min cryolesions resulted in termination of atrial flutter, and later bidirectional block (>120 ms) was confirmed. There was no recurrence post-ablation (>1.5-year follow-up).

Ablation offers a less invasive approach (vs. pacemaker implantation) to toddlers with tachyarrhythmia and coexisting conduction disease, limiting medical management option.