Brugada Terradellas J, Rissech Payret M, Mont Girbau L, Fita Rodríguez G, Bartrons Casas J, Matas Avellà M, Mortera Pérez C, Navarro-López F
Unidad de Arritmias, Hospital Clínic, Barcelona.
An Esp Pediatr. 1998 Apr;48(4):385-8.
The use of radiofrequency ablation of cardiac arrhythmias in pediatrics requires demonstration that the technique is effective and devoid of significant complications. In this study we present our experience in the ablation of cardiac arrhythmias in children and adolescents.
Between January 1992 and January 1997 we performed a total of 1,543 radiofrequency ablation procedures. Of these, 130 were performed in 117 patients younger than 18 years of age (58 were younger than 14 years old). Indication for ablation was the presence of drug refractory recurrent paroxysmal supraventricular tachycardia in 112 patients and permanent ventricular preexcitation in 5 asymptomatic patients. Final diagnosis in the 112 symptomatic patients was: 4 atrial tachycardias, 21 atrio-ventricular nodal reentrant tachycardias, 53 Wolff-Parkinson-White (WPW) syndromes, 33 orthodromic tachycardias using a concealed accessory pathway and 1 idiopathic left ventricular tachycardia.
The initial ablation procedure was effective in 109/117 patients (93%) with a total duration of 90 +/- 31 minutes, using 16 +/- 11 minutes of radioscopy and a median of 4 radiofrequency applications. During follow-up, recurrence occurred in 9 patients (8%). In 7 of them and in 6 of those with an unsuccessful initial procedure, a second effective procedure was performed in 11/13 patients. Finally, radiofrequency ablation was effective in 111/117 patients (95%). We observed a single complication in a 15 year old girl who presented a thrombosis of the right femoral artery requiring balloon recanalization. Comparison of these results with those in the adult population showed no difference in terms of effectiveness, recurrences or complications.
Radiofrequency ablation of cardiac arrhythmias in pediatric and young patients can be safely and effectively done. Results are similar to those obtained in adults suggesting that indications for ablation can also be similar.
小儿心律失常的射频消融治疗需要证明该技术有效且无严重并发症。在本研究中，我们介绍了我们在儿童和青少年心律失常消融方面的经验。
1992年1月至1997年1月期间，我们共进行了1543例射频消融手术。其中，130例在117名18岁以下患者中进行（58名年龄小于14岁）。消融指征为112例药物难治性复发性阵发性室上性心动过速患者和5例无症状患者的永久性心室预激。112例有症状患者的最终诊断为：4例房性心动过速、21例房室结折返性心动过速、53例预激综合征、33例利用隐匿性旁路的顺向性心动过速和1例特发性左室心动过速。
首次消融手术在109/117例患者（93%）中有效，总时长为90±31分钟，使用透视16±11分钟，射频应用中位数为4次。随访期间，9例患者（8%）复发。其中7例以及首次手术未成功的6例患者中，11/13例患者进行了第二次有效手术。最终，射频消融在111/117例患者（95%）中有效。我们观察到1例15岁女孩出现右股动脉血栓形成，需要球囊再通，这是唯一的并发症。将这些结果与成人患者的结果比较，在有效性、复发率或并发症方面无差异。
小儿和年轻患者心律失常的射频消融可以安全有效地进行。结果与成人相似，提示消融指征也可能相似。
