Desai Vibha C A, Kelton Christina M L, Czosek Richard J, Heaton Pamela C
James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio.
Pacing Clin Electrophysiol. 2013 Dec;36(12):1468-80. doi: 10.1111/pace.12191. Epub 2013 Jun 3.
Over the past two decades, catheter ablation (CA) has revolutionized the treatment of tachyarrhythmias in children by providing a relatively safe and effective alternative to open heart surgery or lifelong pharmacotherapy. This study (1) described national trends in pediatric CAs and their associated costs and complications and (2) predicted the likelihood of major complications based on patient and hospital characteristics.
Inpatient data were obtained from the Kids' Inpatient Database for the years 2000, 2003, 2006, and 2009. Outpatient data were obtained from the California, Maryland, and New Jersey State Ambulatory Surgery Databases for the years 2006 and 2009. Logistic regression was used to predict the odds of major complications from CA.
There was a 20% increase (4,134-4,967) in the number of pediatric CAs performed from 2006 to 2009 that was concomitant with a decrease in the percentage of those procedures being performed as inpatient procedures (2,254-1,846). In 2009, a complication rate of 4.81% was estimated. For inpatient CAs, higher risk patients (with congenital heart disease, congestive heart failure, or heart transplant), ablations for ventricular tachycardias, and low-CA-volume hospitals were associated with increased risk of complications. In 2009, the mean cost of a hospitalization involving CA, but no cardiac surgery, was $17,204 (standard error = $1,015).
CA has increasingly been used over the past decade for pediatric patients with a multitude of tachycardia mechanisms. There continues to be a small risk of major complications, especially for higher risk children and in hospitals with more limited experience with the procedure.
在过去二十年中，导管消融术（CA）为儿童快速心律失常的治疗带来了变革，它为开胸手术或终身药物治疗提供了一种相对安全有效的替代方法。本研究（1）描述了儿科CA的全国趋势及其相关成本和并发症，（2）根据患者和医院特征预测主要并发症的发生可能性。
从2000年、2003年、2006年和2009年的儿童住院数据库中获取住院患者数据。从2006年和2009年的加利福尼亚州、马里兰州和新泽西州门诊手术数据库中获取门诊患者数据。采用逻辑回归来预测CA发生主要并发症的几率。
从2006年到2009年，儿科CA手术数量增加了20%（从4134例增至4967例），同时住院手术的比例有所下降（从2254例降至1846例）。2009年，估计并发症发生率为4.81%。对于住院CA手术，高危患者（患有先天性心脏病、充血性心力衰竭或心脏移植）、室性心动过速消融术以及低CA手术量的医院，并发症风险增加。2009年，涉及CA但未进行心脏手术的住院治疗平均费用为17204美元（标准误差 = 1015美元）。
在过去十年中，CA越来越多地用于患有多种心动过速机制的儿科患者。主要并发症的风险仍然较小，尤其是对于高危儿童以及该手术经验较少的医院。
