Jiang He, Li Xiaomei
School of Medicine, Tsinghua University & Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Beijing, China.
Pacing Clin Electrophysiol. 2018 Sep;41(9):1123-1128. doi: 10.1111/pace.13438. Epub 2018 Jul 26.
Radiofrequency catheter ablation (RFCA) in the septum close to the atrioventricular node or His bundle has an increased risk of irreversible complications. Cryothermal energy has the advantages of reversible cryomapping and increased catheter stability. The study aims to evaluate the efficacy and safety of cryoablation of the right anteroseptal or midseptal accessory pathways (APs) in pediatric patients.
A retrospective review was performed with 26 pediatric patients (16 males and 10 females; median age 6.0 years and average body weight 24.9 kg) with paroxysmal supraventricular tachycardia (PSVT) in our Pediatric Heart Center from 2014 to 2016. Half of them had manifest APs. All the children underwent cryoablation for the treatment of PSVT because of the right anteroseptal or midseptal APs (16 cases had right anteroseptal APs and 10 cases had right midseptal APs).
Acute cryoablation success was achieved in 23 cases (88%, 23/26). Atrioventricular block (AVB) occurred in eight cases (31%, 8/26) during the procedures and normal atrioventricular conduction recovered in seven cases except a case with I°AVB. During follow-up, three cases recurred (13%, 3/23) and no permanent high degree AVB was found.
Cryoablation of the right anteroseptal or midseptal APs in pediatric patients is both safe and effective.
在靠近房室结或希氏束的间隔处进行射频导管消融（RFCA）会增加不可逆并发症的风险。低温能量具有可逆性冷冻标测和提高导管稳定性的优点。本研究旨在评估小儿患者右前间隔或中间隔旁路（APs）冷冻消融的有效性和安全性。
对2014年至2016年在我院小儿心脏中心的26例阵发性室上性心动过速（PSVT）小儿患者（男16例，女10例；中位年龄6.0岁，平均体重24.9 kg）进行回顾性研究。其中一半患者有显性APs。所有患儿均因右前间隔或中间隔APs接受冷冻消融治疗PSVT（16例为右前间隔APs，10例为右中间隔APs）。
23例（88%，23/26）实现急性冷冻消融成功。术中8例（31%，8/26）发生房室传导阻滞（AVB），除1例I°AVB外，7例房室传导恢复正常。随访期间，3例复发（13%，3/23），未发现永久性高度AVB。
小儿患者右前间隔或中间隔APs的冷冻消融安全有效。
