Buddhe Sujatha, Singh Harinder, Du Wei, Karpawich Peter P
Section of Pediatric Cardiology, Carmen and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
Pacing Clin Electrophysiol. 2012 Jun;35(6):711-7. doi: 10.1111/j.1540-8159.2012.03372.x. Epub 2012 Mar 27.
Cryoablation (Cryo) has augmented radiofrequency (RF) as the ablation energy choice for most supraventricular tachycardias (SVT). Although initial acute results and more recent, but limited, 3-36-month follow-up studies have been reported, more longer follow-up information is required to determine actual efficacy.
Data from patients with structurally normal hearts who underwent reentrant forms of SVT ablation at our institution from January 2005 to December 2009 were reviewed. These included demographics, clinical and electrophysiologic findings, and ablative energies used. Following apparent acute success, all patients were then reevaluated for any potential recurrences of SVT or preexcitation up to 5 years later.
A total of 155 patients (83 male) were reviewed (mean age 13.4 ± 3.7 years). Ablations were predominantly right-sided (75%). Atrioventricular reciprocating tachycardia was seen in 74% and atrioventricular node reciprocating tachycardia (AVNRT) in 17% of patients. For concerns of atrioventricular node integrity, Cryo ± RF was user-preferred for anteroseptal accessory fiber locations and AVNRT. Acute success rate was 98% and chronic 83.2% over the next 5 years. Among patients with accessory pathways, recurrence was pathway number and location dependent: significantly higher (P < 0.05) if they were right anterior-anteroseptal, multiple, or with a broad-distribution pattern. There were no significant differences in recurrence rates with use of RF or its combination with Cryo.
Radiofrequency ablation and Cryo are both effective therapies for pediatric patients. Although use of Cryo with RF in combination may enhance safety while affording comparable success, risk of recurrence still persists in the current era among patients depending on accessory pathways connection location and characteristics.
冷冻消融术（Cryo）已成为大多数室上性心动过速（SVT）消融能量的首选，补充了射频（RF）消融。尽管已有初始急性结果以及近期（但有限的）3至36个月随访研究的报道，但仍需要更多长期随访信息来确定实际疗效。
回顾了2005年1月至2009年12月在我院接受折返性SVT消融的心脏结构正常患者的数据。这些数据包括人口统计学、临床和电生理检查结果以及所使用的消融能量。在表面上取得急性成功后，对所有患者进行重新评估，以确定在长达5年的时间里是否有SVT或预激综合征的任何潜在复发。
共回顾了155例患者（83例男性）（平均年龄13.4±3.7岁）。消融主要在右侧进行（75%）。74%的患者出现房室折返性心动过速，17%的患者出现房室结折返性心动过速（AVNRT）。出于对房室结完整性的考虑，对于前间隔旁道位置和AVNRT，冷冻消融联合或不联合射频消融是患者更倾向的选择。急性成功率为98%，在接下来的5年中慢性成功率为83.2%。在有旁道的患者中，复发与旁道数量和位置有关：如果旁道位于右前-前间隔、多个或呈广泛分布模式，则复发率显著更高（P<0.05）。使用射频消融或其与冷冻消融联合使用时，复发率没有显著差异。
射频消融和冷冻消融对儿科患者都是有效的治疗方法。尽管联合使用冷冻消融和射频消融可能会提高安全性并取得相当的成功率，但在当前时代，根据旁道连接位置和特征，患者仍有复发风险。
