Drago Fabrizio, Flore Francesco, Raimondo Cristina, Pandozi Claudio
Paediatric Cardiology and Cardiac Arrhythmias Complex Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy.
Front Cardiovasc Med. 2024 Nov 28;11:1506858. doi: 10.3389/fcvm.2024.1506858. eCollection 2024.
Atrioventricular nodal reentrant tachycardia (AVNRT) is a common supraventricular tachycardia in children and congenital heart disease (CHD) patients. Nowadays, in large enough children, chronic treatment for symptomatic and recurrent AVNRT episodes relies on transcatheter ablation. Indeed, many three-dimensional (3D) mapping strategies and ablation techniques have been developed and it helped to increase success rates and to reduce complications. Therefore, this study aimed to perform an updated comprehensive review of the available literature regarding contemporary management of AVNRT in children. A literature search was performed using Google Scholar, PubMed, Springer, Ovid, and Science Direct. We found that in recent times many investigations have demonstrated that 3D mapping systems allow to localize more precisely the ablation substrate, with minimal use of fluoroscopy. The most frequently employed mapping strategies are the low-voltage bridge strategy together with the search for the SP potential and the Sinus Rhythm Propagation Map with the identification of areas of Wave Collision or Pivot Points. For transcatheter ablation in pediatric settings, radiofrequency (RF) ablation was first used in the 1990s, while cryoablation was introduced in 2003 and nowadays represents the most used energy for AVNRT ablation in this population. Indeed, its specific features, such as reversible cryomapping, cryoadhesion and the precision in lesion delivery, made this technique very appealing to decrease complications and fluoroscopy time. As regards AVNRT in CHD patients, it represents the third most common form of arrhythmia in children with CHD. However, in this subgroup ablation remains challenging and experience limited, since anatomy may be atypical and the areas of ablation less predictable or less accessible.
房室结折返性心动过速（AVNRT）是儿童和先天性心脏病（CHD）患者中常见的室上性心动过速。如今，对于年龄足够大的儿童，有症状的复发性AVNRT发作的长期治疗依赖于经导管消融。事实上，已经开发了许多三维（3D）标测策略和消融技术，这有助于提高成功率并减少并发症。因此，本研究旨在对有关儿童AVNRT当代管理的现有文献进行最新的全面综述。使用谷歌学术、PubMed、施普林格、Ovid和科学Direct进行文献检索。我们发现，近年来许多研究表明，3D标测系统能够更精确地定位消融基质，同时减少荧光透视的使用。最常用的标测策略是低压桥接策略以及寻找慢径电位，以及窦性心律传播图并识别波碰撞或折返点区域。在儿科环境中进行经导管消融时，射频（RF）消融于20世纪90年代首次使用，而冷冻消融于2003年引入，如今是该人群中AVNRT消融最常用的能量。事实上，其特定特征，如可逆性冷冻标测、冷冻粘连和病灶递送的精确性，使该技术在减少并发症和荧光透视时间方面非常有吸引力。至于CHD患者的AVNRT，它是CHD儿童中第三常见的心律失常形式。然而，在这个亚组中，消融仍然具有挑战性且经验有限，因为解剖结构可能不典型，消融区域难以预测或难以到达。
