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儿童和青少年室上性心动过速的射频导管消融术:低收入国家的可行性和成本效益

Radiofrequency catheter ablation of supraventricular tachycardia in children and adolescents : feasibility and cost-effectiveness in a low-income country.

作者信息

Vida Vladimiro L, Calvimontes Gonzalo S, Macs Maximo O, Aparicio Patricia, Barnoya Joaquin, Castañeda Aldo R

机构信息

Department of Pediatric Cardiovascular Surgery, UNICAR, Guatemala City, 01011 Guatemala CA.

出版信息

Pediatr Cardiol. 2006 Jul-Aug;27(4):434-9. doi: 10.1007/s00246-006-1220-8. Epub 2006 Jul 6.

Abstract

The objective of this study is to provide results and costs of catheter ablation in children and adolescents in a low-income country. Reports from first-world countries have demonstrated the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared to medical treatment of supraventricular tachycardia (SVT). The study included 28 patients younger than 18 years of age with SVT in a pediatric cardiology unit in Guatemala. All patients underwent RFCA. Clinical outcome and cost-effectiveness of RFCA compared to continued medical treatment were the end points. Twenty-four patients had successful ablation (85.7%). Mean age at RFCA was 11.42 +/- 3.49 years. Three patients underwent a second ablation, increasing the success rate to 96.4%. One remaining patient is awaiting a second procedure. At a mean follow-up of 13.69 +/- 7.16 months, all 27 patients who had a successful ablation remained in sinus rhythm. Mean cost per procedure was 4.9 times higher than that of medical treatment. However, the estimated cost of catheter ablation equal that of medical therapy after 5.1 years and is 3.4 times less after 20 years. Radiofrequency catheter ablation of SVT in children and adolescents is safe and cost-effective compared to medical therapy. Resources must be judiciously allocated, especially in low-income countries, to treat the largest number of pediatric patients.

摘要

本研究的目的是提供低收入国家儿童和青少年导管消融的结果及成本。来自第一世界国家的报告已证明,与室上性心动过速(SVT)的药物治疗相比,射频导管消融(RFCA)具有成本效益。该研究纳入了危地马拉一家儿科心脏病科的28例18岁以下的SVT患者。所有患者均接受了RFCA。将RFCA与持续药物治疗的临床结果和成本效益作为终点。24例患者消融成功(85.7%)。RFCA时的平均年龄为11.42±3.49岁。3例患者接受了第二次消融,成功率提高到96.4%。剩下的1例患者正在等待第二次手术。在平均13.69±7.16个月的随访中,所有27例消融成功的患者均维持窦性心律。每次手术的平均成本比药物治疗高4.9倍。然而,导管消融的估计成本在5.1年后与药物治疗相当,在20年后则比药物治疗低3.4倍。与药物治疗相比,儿童和青少年SVT的射频导管消融是安全且具有成本效益的。必须明智地分配资源,尤其是在低收入国家,以便治疗最多数量的儿科患者。

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