Drago Fabrizio, Russo Mario S, Silvetti Massimo S, DE Santis Antonella, Iodice Francesca, Naso Onofrio Maria Teresa
Pediatric Cardiology Department, Bambino Gesù Hospital, Rome, Italy.
Pacing Clin Electrophysiol. 2010 Apr;33(4):475-81. doi: 10.1111/j.1540-8159.2009.02623.x. Epub 2009 Dec 1.
Cryoablation is an effective and safe treatment for children with supraventricular tachycardias when the reentry circuit is located near the atrioventricular (AV) junction. We retrospectively reviewed consecutive cryoablation procedures for the treatment of atrioventricular nodal reentrant tachycardia (AVNRT) in children and young adults in a single pediatric center.
From October 2002 to October 2008, cryoablation was attempted in 76 pediatric patients (mean age 11.3 +/- 2.4 years, range: 6-16.4 years) with symptomatic typical AVNRT. Cryomapping, used to identify the tissue site for safe arrhythmia ablation, was performed at -30 degrees C for a maximum of 60 seconds. The efficacy of the cryomapping procedure was assessed in terms of disappearance of dual-AV node physiology and noninducibility of AVNRT.
Cryoablations were from 4 to 8 minutes long at -75 degrees C. A single "bonus" cryoapplication (-75 degrees C for minimum 6 minutes) was delivered to consolidate the acutely successful cryoablation for 64 consecutive patients. After the cryoablation procedure, patients were assessed at 1, 3, 6, 12, 18, and 24 months (and then every year thereafter) by a clinical evaluation and standard electrocardiogram, Holter monitoring, and exercise stress testing. No permanent cryo-related complications were reported. Seventy-four (97.4%) patients were successfully acutely ablated. During a mean follow-up of 29.5 months (range 2-74 months), five (6.8%) acutely successful pediatric patients experienced arrhythmia recurrence. We did not identify any predictive factors of AVNRT recurrence.
Acute and long-term results demonstrate that cryoablation of AVNRT can be considered a safe and effective procedure in pediatric patients. (PACE 2010; 475-481).
当折返环路位于房室（AV）交界附近时，冷冻消融是治疗儿童室上性心动过速的一种有效且安全的方法。我们回顾性分析了在一家儿科中心对儿童和青年成人进行的连续性房室结折返性心动过速（AVNRT）冷冻消融治疗病例。
2002年10月至2008年10月期间，对76例有症状的典型AVNRT儿科患者（平均年龄11.3±2.4岁，范围：6 - 16.4岁）尝试进行冷冻消融。冷冻标测用于确定安全心律失常消融的组织部位，在-30℃下进行，最长持续60秒。根据双房室结生理现象的消失和AVNRT的不可诱发性评估冷冻标测程序的疗效。
在-75℃下冷冻消融持续4至8分钟。对64例连续患者进行了一次“额外”冷冻应用（-75℃至少6分钟）以巩固急性成功的冷冻消融。冷冻消融术后，通过临床评估、标准心电图、动态心电图监测和运动负荷试验在1、3、6、12、18和24个月（此后每年）对患者进行评估。未报告与冷冻相关的永久性并发症。74例（97.4%）患者急性消融成功。在平均29.5个月（范围2 - 74个月）的随访期间，5例（6.8%）急性消融成功的儿科患者出现心律失常复发。我们未发现AVNRT复发的任何预测因素。
急性和长期结果表明，AVNRT的冷冻消融在儿科患者中可被视为一种安全有效的方法。（《心律》2010年；475 - 481页）
