Malloy Lindsey, Law Ian H, Von Bergen Nicholas H
Division of Pediatric Cardiology, University of Iowa Hospital and Clinics, 200 Hawkins Drive, 2801 JPP, Iowa City, IA, 52242, USA.
Pediatr Cardiol. 2014 Jan;35(1):103-7. doi: 10.1007/s00246-013-0748-7. Epub 2013 Jul 20.
Voltage guidance for the ablation of the slow pathway in atrioventricular nodal reentry tachycardia (AVNRT) is a dramatic shift from the traditional anatomy-guided approach within the triangle of Koch. The use of voltage gradient mapping has been evaluated in adults as an aid to identification of the slow pathway guiding placement of ablation applications. This study aimed to evaluate this technique of voltage-guided ablation of AVNRT in pediatric and young adult patients, who have a smaller, more compact triangle of Koch. A retrospective cohort study evaluated patients 20 years of age or younger with AVNRT who underwent voltage mapping. Using NavX, three-dimensional voltage maps of the right atrium were created during sinus rhythm, focusing primarily on the triangle of Koch. The voltage map gradients were adjusted to uncover a "voltage bridge" of lower voltage signals. This bridge was used as a surrogate of the slow pathway to guide cryoablation at this site. Of the 31 patients who underwent voltage mapping, three were excluded from the study due to inadequate mapping. All the patients experienced procedural success. In 86 % of the patients, there was an adequate voltage bridge to allow guided ablation. The successful ablation site was within the first three lesions for 60 % of the patients. Two patients experienced recurrence during a median follow-up period of 14 months. It appears that voltage-guided ablation of a voltage bridge in AVNRT can be used effectively and safely in the pediatric population.
房室结折返性心动过速（AVNRT）慢径消融的电压引导与传统的科赫三角内解剖引导方法相比有显著转变。电压梯度标测在成人中的应用已得到评估，以辅助识别引导消融应用放置的慢径。本研究旨在评估这种在小儿和年轻成人患者中应用电压引导消融AVNRT的技术，这些患者的科赫三角更小且更紧凑。一项回顾性队列研究评估了20岁及以下接受电压标测的AVNRT患者。使用NavX在窦性心律期间创建右心房的三维电压图，主要聚焦于科赫三角。调整电压图梯度以揭示低电压信号的“电压桥”。该桥被用作慢径的替代物，在此部位引导冷冻消融。在接受电压标测的31例患者中，3例因标测不充分被排除在研究之外。所有患者手术均成功。86%的患者有足够的电压桥以允许引导消融。60%的患者成功消融部位在前三个消融点内。2例患者在中位随访期14个月期间出现复发。看来，AVNRT中电压桥的电压引导消融在小儿人群中可有效且安全地使用。
