Koca Serhat, Akdeniz Celal, Tuzcu Volkan
Pediatric and Genetic Arrhythmia Center, Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey.
Pediatric Cardiology, Yuksek Ihtisas Hospital, Ankara, Turkey.
J Interv Card Electrophysiol. 2019 Jun;55(1):99-104. doi: 10.1007/s10840-018-0499-8. Epub 2019 Jan 3.
Catheter ablation is the only choice of treatment in some small children with medically refractory supraventricular tachycardia (SVT). Electroanatomical mapping systems (EMS) are more commonly utilized in electrophysiological procedures in recent years, which resulted in a significant decrease in fluoroscopy exposure. The potential benefit of EMS in small children has not been studied. Therefore, we investigated the outcomes of children undergoing catheter ablation weighing ≤ 20 kg using an electroanatomical mapping system.
This study evaluated the outcomes, characteristics, and follow-ups of children ≤ 20 kg who underwent SVT ablations between April 2012 and April 2018 in a pediatric electrophysiology center where EMS were routinely used.
In a 6-year period, 1129 children underwent SVT catheter ablation under EMS guidance at our institution. A total of 84 of them were weighing ≤ 20 kg. The acute success rate was 97.6% in 85 tachycardia substrates. No fluoroscopy was used in 58 of the patients, while a median of 5 (4-14) min of fluoroscopy was used in the remaining 26 patients. Recurrences were seen in 4 patients (4.8%) at a mean follow-up of 3.89 ± 2.08 years. Five patients developed non-vital complications (2 right bundle block and 3 temporary complete block that spontaneously resolved during the procedure).
The outcome of catheter ablation with the guidance of EMS for the treatment of SVT in small children is favorable. Fluoroscopy exposure can be decreased and even eliminated in most patients.
对于一些药物治疗无效的小儿室上性心动过速（SVT），导管消融是唯一的治疗选择。近年来，电解剖标测系统（EMS）在电生理手术中应用更为普遍，这使得透视暴露显著减少。EMS在小儿中的潜在益处尚未得到研究。因此，我们研究了使用电解剖标测系统对体重≤20 kg的小儿进行导管消融的结果。
本研究评估了2012年4月至2018年4月在一家常规使用EMS的儿科电生理中心接受SVT消融的体重≤20 kg儿童的手术结果、特征及随访情况。
在6年期间，我院1129例儿童在EMS引导下接受了SVT导管消融。其中共有84例体重≤20 kg。85种心动过速基质的急性成功率为97.6%。58例患者未使用透视，其余26例患者透视时间中位数为5（4 - 14）分钟。平均随访3.89±2.08年时，4例患者（4.8%）出现复发。5例患者出现非致命性并发症（2例右束支传导阻滞和3例术中自发缓解的暂时性完全性传导阻滞）。
在EMS引导下对小儿SVT进行导管消融的效果良好。多数患者的透视暴露可减少甚至消除。
