Karacan Mehmet, Çelik Nida, Akdeniz Celal, Tuzcu Volkan
Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.
Pacing Clin Electrophysiol. 2018 Mar;41(3):255-260. doi: 10.1111/pace.13277. Epub 2018 Feb 12.
Atrioventricular nodal reentrant tachycardia (AVNRT) is a common tachyarrhythmia substrate in children, which is successfully treated by catheter ablation using radiofrequency or cryothermal energy. In recent years, cryoablation (Cryo) using electroanatomical system guidance is more commonly preferred for use in children in order to decrease the risk of an atrioventricular block. However, there are concerns regarding the long-term efficacy of Cryo in treating AVNRT. We aimed to evaluate the feasibility, safety, and long-term efficacy of Cryo for AVNRT in children.
A total of 275 consecutive children above 4 years of age diagnosed with AVNRT were included in our study. The EnSite system (St. Jude Medical, Inc., St. Paul, MN, USA) was used to reduce or eliminate fluoroscopy. The study included 275 patients (148 females, age: 11.9 ± 3.6 years) undergoing catheter ablation for AVNRT from July 2012 to September 2016. Acute success was obtained in all (100%) patients with a mean procedure time of 140 ± 44 minutes. Fluoroscopy was used in only 12 (4.4%) patients. During a follow-up time of 25.6 ± 13.5 months (median: 23 months), AVNRT recurred in 12 of 279 (4.4%) of the patients. Age, sex, number of Cryo lesions, and catheter tip size (6-mm vs 8-mm) were not predictive for recurrence. In nine patients, a repeat ablation was successfully performed with cryoenergy.
Cryo for AVNRT is a safe and effective procedure with excellent long-term outcomes. The use of electroanatomical systems during ablation significantly decreases exposure to fluoroscopy without compromising success.
房室结折返性心动过速（AVNRT）是儿童常见的快速性心律失常基质，可通过使用射频或冷冻能量的导管消融成功治疗。近年来，为降低房室传导阻滞风险，在儿童中更常首选使用电解剖系统引导的冷冻消融（Cryo）。然而，人们对Cryo治疗AVNRT的长期疗效存在担忧。我们旨在评估Cryo治疗儿童AVNRT的可行性、安全性和长期疗效。
我们的研究纳入了275例连续的4岁以上诊断为AVNRT的儿童。使用EnSite系统（美国明尼苏达州圣保罗市圣犹达医疗公司）减少或消除荧光透视。该研究包括2012年7月至2016年9月期间接受AVNRT导管消融的275例患者（148例女性，年龄：11.9±3.6岁）。所有（100%）患者均获得急性成功，平均手术时间为140±44分钟。仅12例（4.4%）患者使用了荧光透视。在25.6±13.5个月（中位数：23个月）的随访期内，279例患者中有12例（4.4%）AVNRT复发。年龄、性别、Cryo损伤数量和导管尖端尺寸（6毫米与8毫米）对复发无预测性。9例患者使用冷冻能量成功进行了重复消融。
Cryo治疗AVNRT是一种安全有效的手术，长期效果良好。消融过程中使用电解剖系统可显著减少荧光透视暴露，且不影响成功率。
