Scaglione Marco, Ebrille Elisa, Caponi Domenico, Blandino Alessandro, DI Donna Paolo, Siboldi Alessandra, Bertero Giovanni, Anselmino Matteo, Raimondo Cristina, Sardi Davide, Gabbarini Fulvio, Marasini Maurizio, Gaita Fiorenzo
Cardiology Department, Cardinal Massaia Hospital, Asti, Italy.
Pacing Clin Electrophysiol. 2013 Dec;36(12):1460-7. doi: 10.1111/pace.12183. Epub 2013 May 28.
Anatomical considerations and risks related to x-ray exposure make atrioventricular nodal reentrant tachycardia (AVNRT) ablation in pediatric patients a concerning procedure. We aimed to evaluate the feasibility, safety, and efficacy of performing fluoroless slow-pathway cryoablation guided by the electroanatomic (EA) mapping in children and adolescents.
Twenty-one consecutive patients (mean age 13.5 ± 2.4 years) symptomatic for AVNRT were prospectively enrolled to right atrium EA mapping and electrophysiological study prior to cryoablation. Cryoablation was guided by slow-pathway potential and performed using a 4-mm-tip catheter.
Sustained slow-fast AVNRT was inducible in all the patients with a dual AV nodal physiology in 95%. Acute success was achieved in 100% of the patients with a median of two cryo-applications. Fluoroless ablation was feasible in 19 patients, while in two subjects 50 seconds and 45 seconds of x-ray were needed due to difficult progression of the catheters along the venous system. After a mean follow-up of 25 months, AVNRT recurred in five patients. All the recurrences were successfully treated with a second procedure. In three patients, a fluoroless cryoablation with a 6-mm-tip catheter was successfully performed, while in the remaining two patients, a single pulse of 60 seconds of radiofrequency energy was applied under fluoroscopic monitoring. No complications occurred.
Combination of EA mapping systems and cryoablation may allow to perform fluoroless slow-pathway ablation for AVNRT in children and adolescents in the majority of patients. Fluoroless slow-pathway cryoablation showed a high efficacy and safety comparable to conventional fluoroscopy guided procedures.
与X线暴露相关的解剖学因素及风险使得小儿房室结折返性心动过速（AVNRT）消融成为一项令人担忧的操作。我们旨在评估在儿童和青少年中进行无荧光慢径冷冻消融并由电解剖（EA）标测引导的可行性、安全性和有效性。
连续纳入21例有症状的AVNRT患者（平均年龄13.5±2.4岁），在冷冻消融前进行右心房EA标测和电生理研究。冷冻消融由慢径电位引导，使用4毫米尖端导管进行。
所有具有双房室结生理特征的患者中95%可诱发持续性慢快型AVNRT。100%的患者获得急性成功，平均冷冻应用次数为两次。19例患者可行无荧光消融，而两名受试者由于导管在静脉系统中推进困难，需要50秒和45秒的X线照射。平均随访25个月后，5例患者AVNRT复发。所有复发均通过再次手术成功治疗。3例患者成功进行了使用6毫米尖端导管的无荧光冷冻消融，而其余2例患者在透视监测下施加了单次60秒的射频能量脉冲。未发生并发症。
EA标测系统与冷冻消融相结合可使大多数儿童和青少年患者进行无荧光AVNRT慢径消融。无荧光慢径冷冻消融显示出与传统透视引导手术相当的高疗效和安全性。
