Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA.
Circ Arrhythm Electrophysiol. 2020 Nov;13(11):e008848. doi: 10.1161/CIRCEP.120.008848. Epub 2020 Oct 5.
Atrioventricular reentrant tachycardia is common in children. Catheter ablation is increasingly used as a first-line therapy with a high acute success rate, but recurrence during follow-up remains a concern. The aim of this study was to identify risk factors for recurrence after accessory pathway (AP) ablation.
Retrospective cohort study including patients who underwent AP ablation between 2013 and 2018. Cox proportional hazards model was used to examine the association between patient and procedural characteristics and recurrence during follow-up.
From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 (interquartile range, 0.1-1.4) years, there were 42 (8%) patients with documented recurrence. On univariate analysis, early recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and posteroseptal versus left sided), cryoablation (versus radiofrequency), empirical ablation, the lack of full power radiofrequency lesions (<50 W), radiofrequency consolidation time <90 seconds and the use of fluoroscopy without a 3-dimensional electroanatomic mapping system. On multivariable analysis, only multiple AP (hazard ratio, 2.78 [95% CI, 1.063-4.74]) and radiofrequency consolidation time < 90 seconds (hazard ratio, 4.38 [95% CI, 1.92-9.51]) remained significantly associated with early recurrence; this association remained true when analyzed in subgroups by pathway location for right and left free wall AP.
In our institutional experience, radiofrequency consolidation time <90 seconds after ablation of AP was associated with an increased risk of early recurrence.
房室折返性心动过速在儿童中很常见。导管消融术作为一线治疗方法，其急性成功率越来越高，但在随访期间仍存在复发的问题。本研究旨在确定旁路（AP）消融后复发的危险因素。
回顾性队列研究，纳入 2013 年至 2018 年期间行 AP 消融术的患者。使用 Cox 比例风险模型来检验患者和手术特点与随访期间复发之间的相关性。
在 558 例 AP 消融术的患者中，有 542 例（97%）在急性期取得成功。在中位数为 0.4 年（四分位距，0.1-1.4 年）的随访期间，有 42 例（8%）患者的复发得到了记录。在单因素分析中，早期复发与年龄较小、先天性心脏病、多个 AP、AP 位置（右侧和后间隔与左侧）、冷冻消融（而非射频消融）、经验性消融、射频消融功率不足（<50 W）、射频巩固时间<90 秒以及未使用三维电生理标测系统的透视相关。多因素分析显示，只有多个 AP（风险比，2.78[95%CI，1.063-4.74]）和射频巩固时间<90 秒（风险比，4.38[95%CI，1.92-9.51]）与早期复发显著相关；当按右侧和左侧游离壁 AP 的 AP 位置进行亚组分析时，这种相关性仍然成立。
在本机构的经验中，AP 消融后射频巩固时间<90 秒与早期复发风险增加相关。
