Department of Pediatrics, Division of Cardiology, University of Utah and Primary Children's Hospital, 81 Mario Capecchi Dr, Salt Lake City, UT 84112, USA.
Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA.
Europace. 2024 Feb 1;26(2). doi: 10.1093/europace/euae047.
Common to adult electrophysiology studies (EPSs), intracardiac echocardiography (ICE) use in paediatric and congenital heart disease (CHD) EPS is limited. The purpose of this study was to assess the efficacy of ICE use and incidence of associated complications in paediatric and CHD EPS.
This single-centre retrospective matched cohort study reviewed EPS between 2013 and 2022. Demographics, CHD type, and EPS data were collected. Intracardiac echocardiography cases were matched 1:1 to no ICE controls to assess differences in complications, ablation success, fluoroscopy exposure, procedure duration, and arrhythmia recurrence. Cases and controls with preceding EPS within 5 years were excluded. Intracardiac echocardiography cases without an appropriate match were excluded from comparative analyses but included in the descriptive cohort. We performed univariable and multivariable logistic regression to assess associations between variables and outcomes. A total of 335 EPS were reviewed, with ICE used in 196. The median age of ICE cases was 15 [interquartile range (IQR) 12-17; range 3-47] years, and median weight 57 [IQR 45-71; range 15-134] kg. There were no ICE-related acute or post-procedural complications. There were 139 ICE cases matched to no ICE controls. Baseline demographics and anthropometrics were similar between cases and controls. Fluoroscopy exposure (P = 0.02), procedure duration (P = 0.01), and arrhythmia recurrence (P = 0.01) were significantly lower in ICE cases.
Intracardiac echocardiography in paediatric and CHD ablations is safe and reduces procedure duration, fluoroscopy exposure, and arrhythmia recurrence. However, not every arrhythmia substrate requires ICE use. Thoughtful selection will ensure the judicious and strategic application of ICE to enhance outcomes.
与成人电生理研究（EPS）一样，在儿科和先天性心脏病（CHD）EPS 中使用心内超声（ICE）的应用受到限制。本研究的目的是评估 ICE 在儿科和 CHD EPS 中的应用效果和相关并发症的发生率。
这项单中心回顾性匹配队列研究回顾了 2013 年至 2022 年期间的 EPS。收集了人口统计学、CHD 类型和 EPS 数据。将 ICE 病例与 1:1 无 ICE 对照组进行匹配，以评估并发症、消融成功率、透视暴露、手术时间和心律失常复发的差异。排除了之前 5 年内有 EPS 的病例和对照。无适当匹配的 ICE 病例被排除在比较分析之外，但包括在描述性队列中。我们进行了单变量和多变量逻辑回归分析，以评估变量与结局之间的关系。共回顾了 335 次 EPS，其中 196 次使用了 ICE。ICE 病例的中位年龄为 15 岁[四分位间距（IQR）12-17；范围 3-47]，体重中位数为 57 公斤[IQR 45-71；范围 15-134]。没有与 ICE 相关的急性或术后并发症。有 139 例 ICE 病例与无 ICE 对照组匹配。病例和对照组的基线人口统计学和人体测量学特征相似。透视暴露（P=0.02）、手术时间（P=0.01）和心律失常复发（P=0.01）在 ICE 病例中显著降低。
在儿科和 CHD 消融中使用心内超声是安全的，可以缩短手术时间、减少透视暴露和心律失常复发。然而，并非每个心律失常病灶都需要使用 ICE。明智的选择将确保 ICE 的合理和战略性应用，以提高治疗效果。
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