Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University, Göttingen 37099, Germany.
Arrhyhtmia Department, Ospedale San Raffaele, Milano, 20132, Italy.
Europace. 2021 Mar 8;23(3):431-440. doi: 10.1093/europace/euaa325.
Contemporary data from prospective multicentre registries on catheter ablation in pediatric patients are sparse. Aim of the European Pediatric Catheter Ablation Registry EUROPA was to contribute data to fill this gap of knowledge.
From July 2012 to June 2017, data on catheter ablation in pediatric patients (≤18 years of age) including a 1-year follow-up from five European pediatric EP centres were collected prospectively. A total of 683 patients (mean age 12.4 ± 3.9 years, mean body weight 50.2 ± 19 kg) were enrolled. Target tachycardia was WPW/atrioventricular-nodal re-entrant tachycardia (AVRT) in 380 (55.7%) patients, AVNRT in 230 (33.8%) patients, ventricular tachycardia (VT) in 24 (3.5) patients, focal atrial tachycardia (FAT) in 20 (2.9%) patients, IART in 14 (2%) patients, and junctional ectopic tachycardia in 3 (0.45) patients. Overall procedural success was 95.6%. Compared with all other substrates, success was significantly lower in FAT patients (80%, n = 16, P = 0.001). Mean procedure duration was 136 ± 67 min and mean fluoroscopy time was 4.9 ± 6.8 min. Major complications occurred in 0.7% of the patients. No persisting AV block requiring permanent pacing was reported. At 1-year follow-up (605/683 patients, 95%), tachycardia recurrence was reported in 7.8% of patients. Recurrence after VT ablation (33%) was significantly higher (P = 0.001) than after ablation of all other substrates.
The present study proves overall high efficacy and safety of catheter ablation of various tachycardia substrates in pediatric patients. Of note, complication rate was exceptionally low. Long-term success was high except for patients after VT ablation.
目前，有关儿科患者心导管消融术的前瞻性多中心注册研究数据较为匮乏。欧洲儿科心导管消融登记研究（EUROPA）旨在提供相关数据，填补这一知识空白。
从 2012 年 7 月至 2017 年 6 月，来自欧洲 5 个儿科电生理中心的前瞻性收集了儿科患者（≤18 岁）接受心导管消融术的数据，包括 1 年的随访。共纳入 683 例患者（平均年龄 12.4±3.9 岁，平均体重 50.2±19kg）。目标心动过速为 WPW/房室结折返性心动过速（AVRT）380 例（55.7%），房室结折返性心动过速 230 例（33.8%），室性心动过速 24 例（3.5%），局灶性房性心动过速 20 例（2.9%），心内折返性心动过速 14 例（2%），交界性异位性心动过速 3 例（0.45%）。总体手术成功率为 95.6%。与所有其他消融靶点相比，局灶性房性心动过速患者的成功率显著较低（80%，n=16，P=0.001）。平均手术时间为 136±67 分钟，平均透视时间为 4.9±6.8 分钟。0.7%的患者发生主要并发症。无持续性房室传导阻滞需要永久性起搏。在 1 年的随访中（683 例患者中有 605 例，95%），7.8%的患者报告心动过速复发。VT 消融后复发率（33%）明显高于其他消融靶点（P=0.001）。
本研究证明了儿科患者各种心动过速消融靶点的整体高效和安全性。值得注意的是，并发症发生率异常低。除 VT 消融后患者外，长期成功率较高。
