Bar-Cohen Yaniv, Cecchin Frank, Alexander Mark E, Berul Charles I, Triedman John K, Walsh Edward P
Electrophysiology Division, Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
Heart Rhythm. 2006 Mar;3(3):253-8. doi: 10.1016/j.hrthm.2005.11.029.
Cryoablation may offer advantages over radiofrequency (RF) ablation for certain arrhythmia substrates, such as septal accessory pathways (APs). Data for young patients, especially regarding recurrence risk, require expansion.
The purpose of this study was to study institutional outcomes for cryoablation of APs located in potentially difficult septal regions for children and young adults.
Cryoablation was attempted in 35 young patients (mean age 15.6 years) with 37 APs that were either close to normal conduction tissues or inside the coronary venous system. Outcomes were compared with previously published institutional data for RF ablation at these same locations.
Acute cryoablation success was achieved for 29 (78%) of 37 APs. Apart from permanent PR prolongation in one case and right bundle branch block in one other, there were no detrimental effects on normal conduction. At median follow-up of 207 days (range 2-695 days), AP conduction recurred for 13 (45%) of 29 ablated APs. Younger patient age and midseptal AP location correlated with higher likelihood of recurrence. Acute success rates for cryoablation were similar to RF ablation in our laboratory, but recurrence rates were significantly higher (P <.001).
Cryoablation yields acute success rates comparable with RF ablation for difficult septal APs in young patients. The risk of AP recurrence appears higher after cryoablation, although safety benefits may provide suitable compensation for this deficiency. Methods for creating more effective cryoablation lesions need to be explored.
对于某些心律失常基质，如间隔旁道（APs），冷冻消融可能比射频（RF）消融具有优势。关于年轻患者的数据，尤其是复发风险方面的数据，需要进一步扩充。
本研究旨在探讨儿童和年轻成人中位于潜在困难间隔区域的APs冷冻消融的机构治疗结果。
对35例年轻患者（平均年龄15.6岁）的37条APs进行冷冻消融尝试，这些APs要么靠近正常传导组织，要么位于冠状静脉系统内。将结果与之前发表的同一部位RF消融的机构数据进行比较。
37条APs中有29条（78%）实现了急性冷冻消融成功。除1例出现永久性PR间期延长和另1例出现右束支传导阻滞外，对正常传导无不良影响。在207天（范围2 - 695天）的中位随访期内，29条已消融APs中有13条（45%）出现AP传导复发。患者年龄较小和间隔中部AP位置与较高的复发可能性相关。在我们实验室，冷冻消融的急性成功率与RF消融相似，但复发率显著更高（P <.001）。
对于年轻患者困难的间隔APs，冷冻消融产生的急性成功率与RF消融相当。冷冻消融后AP复发风险似乎更高，尽管安全性优势可能为此缺陷提供适当补偿。需要探索创建更有效冷冻消融灶的方法。
