Amdani Shahnawaz M, Sallaam Salaam, Karpawich Peter P, Aggarwal Sanjeev
Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, The Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.
Pediatr Cardiol. 2017 Oct;38(7):1426-1433. doi: 10.1007/s00246-017-1680-z. Epub 2017 Jul 15.
Although transcatheter arrhythmia ablation (TCA) has been performed in children for over two decades, guidelines for routine use of post-ablation transthoracic echocardiography (TTE) are absent. We sought to determine the efficacy of TTE after apparently uneventful TCA procedures in detecting adverse findings and identify predisposing factors. A retrospective review of clinical and procedural data on patients who underwent TCA for supraventricular arrhythmias from 2000 to 2015 was performed. Pre- and post-ablation TTE data were reviewed. All patients were followed at 1 week, 6 and 12 months post-TCA. A repeat TTE was performed at 12 months on patients in whom post-TCA abnormalities were found. Patients were divided into two groups: those with and without adverse TTE findings and comparative analysis between variables was performed. Data on 252 patients, 52% males, mean age 14 ± 3 years were analyzed. New onset or worsening atrioventricular valve regurgitation occurred in 17 (6.7%), a small pericardial effusion in 3 (1.2%) and worsened ventricular function in 2 patients (0.8%). Patients in the complication group had higher mean number of ablations (22.6 ± 15.3 vs. 16.8 ± 9.2, p 0.001) and required longer duration of ablation (sec) (254.6 ± 256.4 vs. 180.9 ± 158.9, p < 0.001). TCA location (including coronary sinus), energy source, arrhythmia substrate, and a trans-septal approach were noncontributory to any adverse findings. Routine post-ablation TTE uncovers asymptomatic self-resolving abnormalities that typically do not require any intervention.
尽管经导管心律失常消融术（TCA）在儿童中已开展了二十多年，但目前尚无关于消融术后常规经胸超声心动图（TTE）检查的使用指南。我们旨在确定在TCA手术看似顺利的情况下，TTE检测不良结果的有效性，并识别相关易感因素。我们对2000年至2015年因室上性心律失常接受TCA治疗的患者的临床和手术数据进行了回顾性分析。回顾了消融术前和术后的TTE数据。所有患者在TCA术后1周、6个月和12个月进行随访。对术后发现异常的患者在12个月时进行了重复TTE检查。患者分为两组：TTE检查结果有不良和无不良的患者，并对变量进行了对比分析。分析了252例患者的数据，其中男性占52%，平均年龄14±3岁。17例（6.7%）出现新发或加重的房室瓣反流，3例（1.2%）出现少量心包积液，2例（0.8%）出现心室功能恶化。并发症组患者的平均消融次数更多（22.6±15.3比16.8±9.2，p<0.001），消融持续时间更长（秒）（254.6±256.4比180.9±158.9，p<0.001）。TCA的位置（包括冠状窦）、能量来源、心律失常基质和经房间隔途径与任何不良结果均无关。消融术后常规TTE检查可发现无症状且可自行缓解的异常情况，通常无需任何干预。
