Effect of radiofrequency catheter ablation for different types of tachyarrhythmias in 1000 children / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the success rate,factors associated with recurrence,safety and effect of age on results of radiofrequency catheter ablation(RFCA) for different types of tachyarrhythmias in children.Methods A thousand children diagnosed as tachyarrhythmias underwent electrophysiological study (EPS),with mean age (7.6 ±3.8) years old(0.33-16.50 years old).RFCA methods and results for different kinds of tachyarrhythmias along with recurrence and complications were analyzed.RFCA results for different age groups were compared.Results A thousand children underwent EPS.The number of atrioventricular reentrant tachycardia(AVRT) was 560 (56％),atrioventricular nodal reentrant tachycardia (AVNRT) was 210 (21％),ventricular tachycardia/ventricular premature contraction (VT/PVC) was 159 (15.9％),focal atrial tachycardia (FAT) was 49 (4.9％),and atrial flutter/incisional reentrant atrial tachycardia (AF/IRAT) was 22 (2.2％).Totally 958 children underwent RFCA,among whom success rate was 96.2％ and recurrence rate was 8.1％.EPS performed on recurred cases showed restoration of primary pathway/origin was 5.3％,while appearance of new pathway/origin was 2.8％.Five hundred and thirty-three AVRT cases underwent RFCA,among whom success rate was 98.0％,recurrence rate was 8.4％,restoration of primary pathway was 4.0％,and appearance of new pathway was 4.4％.Success rate of right anterior/mid septal pathway was relatively low (85.3 ％),but its rate of restoration of primary pathway was high (31.0％),as 205 cases of AVNRT underwent RFCA,among whom success rate was 100％,recurrence rate was 5.9％,and restoration of primary origin was 4.9％,while 22 cases of AF/IRAT underwent RFCA,among whom success rate was 95.5％ with no recurrence,46 cases of FAT underwent RFCA,in which success rate was 84.8％ ; success rates for two-dimensional mapping group and three-dimensional mapping combined with cool-tip ablation group were 62.5％ and 96.7％ respectively and the difference was significant (P ＜ 0.05),as 10 cases recurred in which 7 originated from atrial appendages,and these 7 cases were successfully cured by appendectomy,152 cases of VT/PVC underwent RFCA,in which success rate was 89.5％,recurrence rate was 6.6％,restoration of primary origin was 5.9％.There was no difference in success rate between different age groups.The gross success rates and success rates for different types of arrhythmias between early and late periods were not different,while recurrence rates for AVNRT and left anterior pathways in early periods were significantly higher than late periods(P ＜0.05).There were totally 8 cases with complications(0.84％),including 2 cases of complete atrioventricular block and 1 case of anesthetic accident which happened in early period.The other 5 were vascular complications,and there was no death.Conclusions RFCA can be safely used as frontline treatment to cure some kinds of tachyarrhythmias in children with high success rate and low recurrence rate.There is no difference in rates of success,recurrence and complication between younger and older children,while difficulty for procedure increased for the former so that caution should be made for selection of patients.Application of three-dimensional mapping for difficult arrhythmias can increase success rate for ablation.Proficient experience and skillful manipulation are the main factors to avoid complications.