Balli Sevket, Kucuk Mehmet, Orhan Bulut Mustafa, Kemal Yucel Ilker, Celebi Ahmet
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training & Research Hospital, Istanbul, Turkey.
Acta Cardiol Sin. 2018 Jul;34(4):337-343. doi: 10.6515/ACS.201807_34(4).20180326A.
Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common supraventricular tachycardia substrates. The aim of this study was to demonstrate the excellent outcomes of cryoablation without fluoroscopy in pediatric patients with AVNRT.
From September 2015 to October 2016, a transcatheter cryoablation procedure was performed in 109 patients using the EnSite® system. After electrophysiologic studies, a cryoablation catheter was advanced for the purpose of ablation of the slow pathway. Six to eight lesions were delivered in 240-300 seconds at -70 °C, with special effort being paid to obtain an eyeball formation around the first effective lesion.
The mean weight and age of the patients were 24.6 ± 5.3 kg (15-68 kg) and 9.8 ± 2.6 years (5-18 years), respectively. The mean procedure time was 109.8 ± 46 minutes, and the acute procedural success rate was excellent (100%). Ablation procedures were performed during induced tachycardia in 67 patients and during sinus rhythm in 42. The mean follow-up period was 13.3 ± 5.8 months (4-17 months). Recurrence was noted in one patient during the follow-up period who received the ablation procedure with a 6-mm tip catheter. No recurrence was noted among the patients treated with an 8-mm cryocatheter. No permanent cryoablation-related complications occurred.
Cryoablation using an electroanatomic mapping system is safe and effective in pediatric patients with AVNRT, and has the advantage of avoiding ionizing radiation.
房室结折返性心动过速（AVNRT）是最常见的室上性心动过速基质之一。本研究的目的是证明在小儿AVNRT患者中进行无荧光透视的冷冻消融术具有良好的效果。
2015年9月至2016年10月，使用EnSite®系统对109例患者进行了经导管冷冻消融术。在进行电生理研究后，推进冷冻消融导管以消融慢径路。在-70°C下于240 - 300秒内施加6至8个消融点，特别注意在第一个有效消融点周围形成“眼球样”结构。
患者的平均体重和年龄分别为24.6±5.3 kg（15 - 68 kg）和9.8±2.6岁（5 - 18岁）。平均手术时间为109.8±46分钟，急性手术成功率极佳（100%）。67例患者在诱发心动过速期间进行消融手术，42例在窦性心律期间进行。平均随访期为13.3±5.8个月（4 - 17个月）。随访期间，1例使用6 mm尖端导管进行消融手术的患者出现复发。使用8 mm冷冻导管治疗的患者未出现复发。未发生与冷冻消融相关的永久性并发症。
使用电解剖标测系统进行冷冻消融术在小儿AVNRT患者中安全有效，且具有避免电离辐射的优点。
