桥接成功：一种更好的儿童房室结折返性心动过速冷冻消融方法。
Bridge to success: A better method of cryoablation for atrioventricular nodal reentrant tachycardia in children.
机构信息
Division of Pediatric Cardiology, Stanford University, Palo Alto, California.
Division of Pediatric Cardiology, Stanford University, Palo Alto, California.
出版信息
Heart Rhythm. 2017 Nov;14(11):1649-1654. doi: 10.1016/j.hrthm.2017.07.018. Epub 2017 Jul 14.
BACKGROUND
Cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is associated with higher recurrence rates than radiofrequency ablation (RFA). Junctional tachycardia marks procedural success with RFA, but no such indicator exists for cryoablation.
OBJECTIVE
The purpose of this study as to determine the impact of voltage mapping plus longer ablation lesions on midterm success of cryoablation for children with AVNRT.
METHODS
We performed a single-center retrospective analysis of pediatric patients with AVNRT who underwent cryoablation from 2011 to 2015. Patients ablated using a standard electroanatomic approach (control) were compared with patients ablated using voltage mapping (voltage group). In the voltage group, EnSite NavX navigation and visualization technology (St Jude Medical, St Paul, MN) was used to develop a "bridge" of lower voltage gradients (0.3-0.8 mV) of the posteroseptal right atrium to guide cryoablation. Kaplan-Meier analysis was used to determine freedom from recurrence of supraventricular tachycardia.
RESULTS
In all, 122 patients were included (71 voltage, 51 control). There was no difference between groups regarding age, sex, or catheter-tip size. Short-term success was similar in both groups (98.5% voltage vs 92% control; P = .159), but recurrence rates were lower in the voltage group (0% vs 11%, P = .006). Follow-up time was shorter in the voltage group (15 ± 7 months vs 22 ± 17 months, P < .05). The 1-year freedom from recurrence was lower in the voltage group (100% vs 91.5%, P <.05). Ablation times were longer in the voltage group (43.7 ± 20.9 minutes vs 34.3 ± 20.5 minutes, P = .01), but overall procedure times were shorter in the voltage group (157 ± 40 minutes vs 198 ± 133 minutes; P = .018). No significant complication was seen in either group.
CONCLUSION
Voltage gradient mapping and longer lesion time can decrease recurrence rates in pediatric patients with AVNRT.
背景
与射频消融（RFA）相比，冷冻消融治疗房室结折返性心动过速（AVNRT）的复发率更高。RFA 以出现交界性心动过速作为手术成功的标志，但冷冻消融并无此类指标。
目的
本研究旨在探讨电压标测联合更长消融时间对儿童 AVNRT 冷冻消融中期疗效的影响。
方法
我们对 2011 年至 2015 年接受冷冻消融治疗的 AVNRT 患儿进行了单中心回顾性分析。采用标准电生理方法消融的患者为对照组（n = 51），采用电压标测的患者为电压组（n = 71）。电压组使用 EnSite NavX 导航和可视化技术（圣犹达医疗公司，明尼苏达州圣保罗市）构建一条连接右房后间隔下部低电压梯度（0.3-0.8 mV）的“桥梁”，指导冷冻消融。采用 Kaplan-Meier 分析评估无室上性心动过速复发的情况。
结果
共纳入 122 例患者（71 例电压组，51 例对照组）。两组间年龄、性别和导管尖端大小无差异。两组患者短期成功率相似（98.5%电压组 vs 92%对照组；P =.159），但电压组的复发率较低（0% vs 11%；P =.006）。电压组随访时间较短（15 ± 7 个月 vs 22 ± 17 个月；P <.05）。电压组 1 年无复发率较低（100% vs 91.5%；P <.05）。电压组消融时间较长（43.7 ± 20.9 分钟 vs 34.3 ± 20.5 分钟；P =.01），但总手术时间较短（157 ± 40 分钟 vs 198 ± 133 分钟；P =.018）。两组均未出现严重并发症。
结论
电压梯度标测联合更长的消融时间可降低儿童 AVNRT 患者的复发率。
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