Arrhythmia Complex Unit, Medical and Surgical Paediatric Cardiology Department, Bambino Gesù Children's Hospital, Via Torre di Palidoro, snc, 00050 Palidoro, Fiumicino (Rome), Italy.
Europace. 2013 Nov;15(11):1651-6. doi: 10.1093/europace/eut122. Epub 2013 May 14.
The aim of this study was to report the 10-year experience of our Institution in cryoablation of supraventricular tachycardia due to a right accessory pathway (AP).
Seventy-one cryoablations of right AP were performed between July 2002 and October 2011 in our Institution in 66 patients (mean age 12 + 3 years, 56% males). Acute procedural success rate was 97%: 80% in patients with concealed AP and 100% in those with manifest AP (P < 0.05). Acute procedural success rate was not related to institutional experience. No permanent complication occurred. Sixteen patients had recurrences during the follow-up (18.6 ± 6.6 months; range 3-111), 13 within the first month of follow-up, 2 within the 6 months of follow-up, and 1 within 12 months of follow-up. Cox regression showed that sex, patient age, number of delivered cryo-bonus, and presence of manifest or concealed AP are not independent predictors of procedural success. Among the 16 patients with recurrences, in 10 a cryoablation redo was successful and with no further AP recurrences. The mean fluoroscopy time was 28.4 min (range 19.7-44.6) with a significant decrease (P = 0.033) in relation to the increase of the institutional experience. There were no permanent ablation-related complications.
Cryoablation of right-sided AP is effective and very safe in children. Better results are achieved in manifest AP. The learning curve has a real impact in the attempt to reduce the fluoroscopy time.
本研究旨在报告本机构在经导管冷冻消融治疗右侧旁路（AP）引起的室上性心动过速的 10 年经验。
在本机构，2002 年 7 月至 2011 年 10 月期间，对 66 例患者（平均年龄 12+3 岁，56%为男性）共进行了 71 次右侧 AP 冷冻消融术。即刻手术成功率为 97%：隐匿性 AP 患者为 80%，显性 AP 患者为 100%（P＜0.05）。即刻手术成功率与机构经验无关。无永久性并发症发生。随访期间有 16 例患者复发（18.6±6.6 个月；范围 3-111 个月），其中 13 例在随访的第一个月内复发，2 例在随访的 6 个月内复发，1 例在随访的 12 个月内复发。Cox 回归分析显示，性别、患者年龄、冷冻消融能量的应用次数、AP 的显性或隐匿性均不是手术成功的独立预测因素。在 16 例复发患者中，有 10 例再次冷冻消融成功，且未再发生 AP 复发。透视时间平均为 28.4 分钟（范围 19.7-44.6），随着机构经验的增加而显著减少（P=0.033）。无永久性消融相关并发症。
在儿童中，经导管冷冻消融治疗右侧 AP 是有效且非常安全的。显性 AP 患者的疗效更好。学习曲线对尝试减少透视时间有实际影响。
