Gartenberg Ari J, Pass Robert H, Ceresnak Scott, Nappo Lynn, Janson Christopher M
Albert Einstein College of Medicine, 1300 Morris Park Ave, Bronx, NY, 10461, USA.
Division of Cardiology, Children's Hospital at Montefiore / Albert Einstein College of Medicine, 3415 Bainbridge Ave, Bronx, NY, 10467, USA.
Pediatr Cardiol. 2019 Mar;40(3):497-503. doi: 10.1007/s00246-018-1999-0. Epub 2018 Oct 12.
There are few data on the incidence of echocardiographic (echo) abnormalities following catheter ablation in children in the era of 3D mapping. Wide practice variation exists regarding routine post-ablation echo. We hypothesized a low incidence of clinically significant echo abnormalities following SVT ablation in otherwise healthy children. Single center data from 2009 to 2015 were reviewed; routine post-ablation echo was standard practice. Cases were categorized as utilizing fluoroscopy alone (FLUORO) or 3D mapping with a low fluoroscopic protocol (CARTO3). Congenital heart disease was excluded. Outcomes of interest included new valvular abnormalities, pericardial effusions, and wall motion abnormalities. Findings were compared to baseline studies when available and classified as normal/unchanged, clinically insignificant, or clinically significant. Outcomes were compared between FLUORO and CARTO3 groups. Of 347 ablations, 319 (92%) underwent post-procedural echo: 57% male; 55% FLUORO; mean age 13.4 ± 3.6 years. The most common ablation target was an accessory pathway (AP) in 66% (n = 144 WPW, 66 concealed), followed by AVNRT in 32% (n = 102). Radiofrequency (RF) energy was utilized in 82% (n = 262). Post-ablation echos were normal in 81% (n = 259). Clinically insignificant findings were seen in 18% (n = 58), most commonly trivial-small pericardial effusions in 11% (n = 34). Two significant findings required additional follow-up or treatment. There were no cases of wall motion abnormalities or clinically significant effusions. There were no differences in frequency of echo abnormalities between the FLUORO and CARTO3 groups. Clinically significant echocardiographic abnormalities are rare following SVT ablation in children with structurally normal hearts, independent of the use of 3D mapping.
在三维标测时代，关于儿童导管消融术后超声心动图（echo）异常发生率的数据较少。在常规消融术后超声检查方面，存在广泛的实践差异。我们推测，在其他方面健康的儿童中，室上性心动过速（SVT）消融术后具有临床意义的echo异常发生率较低。回顾了2009年至2015年的单中心数据；常规消融术后超声检查是标准做法。病例分为仅使用荧光透视（FLUORO）或采用低荧光透视方案的三维标测（CARTO3）。排除先天性心脏病。感兴趣的结果包括新的瓣膜异常、心包积液和室壁运动异常。如有基线研究，将结果与之比较，并分类为正常/无变化、临床意义不显著或具有临床意义。比较了FLUORO组和CARTO3组的结果。在347例消融术中，319例（92%）进行了术后echo检查：男性占57%；FLUORO占55%；平均年龄13.4±3.6岁。最常见的消融靶点是旁路（AP），占66%（n = 144例预激综合征，66例隐匿性），其次是房室结折返性心动过速（AVNRT），占32%（n = 102例）。82%（n = 262例）使用了射频（RF）能量。81%（n = 259例）的消融术后echo检查结果正常。18%（n = 58例）出现临床意义不显著的结果，最常见的是11%（n = 34例）的微量心包积液。两项具有临床意义的结果需要进一步随访或治疗。没有室壁运动异常或具有临床意义的积液病例。FLUORO组和CARTO3组之间echo异常的发生率没有差异。在结构正常心脏的儿童中，SVT消融术后具有临床意义的超声心动图异常很少见，与三维标测的使用无关。
