Joung Boyoung, Lee Moonhyoung, Sung Jung-Hoon, Kim Jong-Youn, Ahn Shinki, Kim Sungsoon
Division of Cardiology, Yonsei Cardiovascular Hospital and Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Circ J. 2006 Mar;70(3):278-84. doi: 10.1253/circj.70.278.
There remains to be issues regarding radiofrequency catheter ablation (RFCA) in pediatric patients that are different to those involving adults. This study was performed to determine the efficacy and safety of RFCA in pediatric patients.
During the period from 1992 to 2003, 2,734 patients underwent RFCA and 131 pediatric patients who were < or =15 years old (70 males, mean age 12.0+/-3.1 years) were analyzed, retrospectively. The number of accessory pathways (APs) mediating atrioventricular re-entrant tachycardia was 93 (71.4%) and atrioventricular nodal re-entrant tachycardia (AVNRT) was 27 (20.5%). The most common indications for the RFCA were the ;patient's choice' in 94 (71.2%) and 'medically refractory tachycardia' in 29 (22.0%). The age-related indication of the ;patient's choice' was 80.4% (82 of 102) for those >10 years old and 40.0% (12 of 30) for those < or =10 years old (p=0.01). RFCA was performed without sedation in 87.3% (89 of 102) of the subjects >10 years old as compared to 20.0% (6 of 30) of those < or =10 years old (p=0.01). The success rate was 92.8% (90 of 97 APs) for the ablation of APs, and 96.3% (26 of 27) for that of AVNRT. The overall complication rate was 3.8% (5 of 131). During a mean follow-up duration of 13.1+/-2.5 months, the freedom of recurrence was 87.8% (79 of 90) for the arrhythmia associated with APs and 92.3% (24 of 26) for AVNRT.
RFCA in pediatric patients had a good success rate with acceptable recurrence and complication rates when compared to adult patient results. Therefore, RFCA could be considered as the first line of therapy for arrhythmias with concealed and manifested APs and AVNRT in pediatric patients.
小儿患者的射频导管消融术（RFCA）存在一些与成人不同的问题。本研究旨在确定RFCA在小儿患者中的疗效和安全性。
回顾性分析1992年至2003年期间接受RFCA的2734例患者，其中131例年龄小于或等于15岁的小儿患者（70例男性，平均年龄12.0±3.1岁）。介导房室折返性心动过速的附加旁路（APs）数量为93条（71.4%），房室结折返性心动过速（AVNRT）为27例（20.5%）。RFCA最常见适应证中，“患者选择”占94例（71.2%），“药物难治性心动过速”占29例（22.0%）。年龄相关的“患者选择”适应证在大于10岁者中占80.4%（102例中的82例），在小于或等于10岁者中占40.0%（30例中的12例）（p = 0.01）。大于10岁的受试者中87.3%（102例中的89例）在无镇静情况下接受RFCA，而小于或等于10岁者中这一比例为20.0%（30例中的6例）（p = 0.01）。APs消融成功率为92.8%（97条APs中的90条），AVNRT消融成功率为96.3%（27例中的26例）。总体并发症发生率为3.8%（131例中的5例）。在平均13.1±2.5个月的随访期内，与APs相关心律失常的复发率为87.8%（90例中的79例），AVNRT为92.3%（26例中的24例）。
与成人患者结果相比，小儿患者的RFCA成功率良好，复发率和并发症发生率可接受。因此，RFCA可被视为小儿患者隐匿性和显性APs及AVNRT所致心律失常的一线治疗方法。
