Koca Serhat, Akdeniz Celal, Karacan Mehmet, Tuzcu Volkan
Pediatric and Genetic Arrhythmia Center, Pediatric Cardiology, Istanbul Medipol University,Istanbul,Turkey.
Cardiol Young. 2019 Jun;29(6):793-799. doi: 10.1017/S1047951119000830. Epub 2019 Jun 6.
Catheter ablation of left posterior fascicular ventricular tachycardia in the pediatric population remains challenging, and most studies about this topic have been conducted on adult patients. This study aimed to assess the clinical presentation features and outcomes of catheter ablations performed using limited fluoroscopy with three-dimensional electroanatomic mapping system guidance in a pediatric left posterior fascicular ventricular tachycardia patient group.
A total of 20 consecutive patients undergoing left posterior fascicular ventricular tachycardia ablation at a single tertiary centre were enrolled. All children with left posterior fascicular ventricular tachycardia underwent electrophysiological studies using the EnSite NavX system guidance. Ablations were performed during the sinus rhythm based on the Purkinje potentials in all patients.
The mean patient age was 12.7 years (range 2-16), and the mean patient weight was 51 kg (range 11-84). The mean procedure and median fluoroscopy times were 143.1 minutes and 3.4 minutes, respectively. No fluoroscopy was used in three patients. Acute success was achieved in 19 patients (95%). During a mean follow-up of 38.6 ± 19.35 months, left posterior fascicular ventricular tachycardia recurred in four patients (20%). Repeat ablations were performed successfully in those patients who developed recurrences. No complications were seen.
Catheter ablation of left posterior fascicular ventricular tachycardia in children can be performed safely and effectively with low fluoroscopy exposure using a three-dimensional electroanatomic mapping system.
小儿左后分支性室性心动过速的导管消融仍然具有挑战性，关于该主题的大多数研究都是在成年患者中进行的。本研究旨在评估在小儿左后分支性室性心动过速患者组中，在三维电解剖标测系统引导下使用有限透视进行导管消融的临床表现特征和结果。
在一个单一的三级中心，连续纳入20例接受左后分支性室性心动过速消融的患者。所有左后分支性室性心动过速患儿均在EnSite NavX系统引导下进行电生理研究。所有患者均在窦性心律下基于浦肯野电位进行消融。
患者平均年龄为12.7岁（范围2 - 16岁），平均体重为51 kg（范围11 - 84 kg）。平均手术时间和透视时间中位数分别为143.1分钟和3.4分钟。3例患者未使用透视。19例患者（95%）获得急性成功。在平均38.6 ± 19.35个月的随访期间，4例患者（20%）左后分支性室性心动过速复发。对复发患者成功进行了再次消融。未观察到并发症。
使用三维电解剖标测系统，小儿左后分支性室性心动过速的导管消融可以在低透视暴露下安全有效地进行。
