| Objective: Paroxysmal supraventricular tachycardia(PSVT)is a common arrhythmia in children.Persistent or frequent tachycardia can lead to heart enlargement,which decreased cardiac function and seriously endanger children’s health.Radiofrequency catheter ablation(RFCA)is the preferred method for radical treatment of PSVT in children.This study discusses the efficacy and safety of Ensite Nav X system guided RFCA in the treatment of PSVT in children,summarizes the technical difficulties and operational experience,and aims to provide clinical reference.Methods: Children with PSVT who received Ensite Nav X system guided RFCA treatment in our hospital from January 2017 to December 2022 were selected as the research subjects.According to the results of intracavitary electrocardiographic study(EPS),the participants were divided into atrioventricular reentrant tachycardia(AVRT)group and atrioventricular nodal reentrant tachycardia(AVNRT)group.The AVRT group was divided into left-sided accessory pathways(LAP)group and right-sided accessory pathways(RAP)group.The LAP group was divided into transseptal approach(TS)ablation group and transaortic approach(TA)ablation group.The medical records,clinical features,ECG,chest radiograph,echocardiogram,EPS results,surgical process,surgical success rate,recurrence rate,complication rate and postoperative follow-up of Children were collected.The efficacy and safety of Ensite Nav X guided RFCA treatment were statistically analyzed in each group.Results: 1.A total of 89 children with PSVT were included in the study,including42 males and 47 females.The age of onset of the children ranged from 3 months～15 years old,with an average of(7.4±3.6)years.Age distribution of onset: 12 cases(13.5%)≤3 years old,72 cases(80.9%)between 3～13 years old,5 cases(5.6%)≥ 13 years old.The mean age at the definitive diagnosis of PSVT was(7.7±3.7)years.The mean age of the children received RFCA treatment was(9.0±3.4)years.The weight of the children was between 15.6～77.0 kg,and the average was(37.5 ± 13.7)kg.Two children had congenital heart disease,one was LAP with atrial septal defect(approximately 2 mm in size),and the other was RAP and perpetual left superior vena cava.One case with RAP had pre-excitation cardiomyopathy.2.Clinical characteristics of supraventricular tachycardia(SVT)in children: infants aged≤3 years old have reduced food expectation,pallor,vomiting and irritability as the main clinical symptoms at the onset,and children aged >3 years old have chest tightness,palpitation,fatigue and poor spirit as the main clinical symptoms.At the first onset of the child,41 cases had no obvious cause,25 cases appeared after fever or infection,20 cases appeared after exercise,exertion or mood swings,2 cases appeared after a full meal,and1 case appeared during surgical anesthesia induction.3.All children received EPS,the results showed that 67 cases(75.3%)were AVRT and 22cases(24.7%)were AVNRT.In the AVRT group,30 cases were RAP and 37 cases were LAP.In the RAP group,24 cases were free wall APs(including 1 double AP),3 cases were interval APs,and 3cases’ APs were para-his bundle(HB).In the LAP group,33 cases were free wall APs(including 1 double AP),and 4 cases were interval APs.In the AVNRT group,19 cases were slow-fast type and 3 cases were fast-slow type.4.A total of 87 children in children had successful ablation,and the immediate success rate of surgery was 97.8%(87/89).Two children were not successfully ablated.After the postoperative follow-up(20 ± 12.5)months of all children,2 children relapsed after successful ablation,and the overall recurrence rate was 2.2%(2/89),of which one child with LAP was ventricular pre-excitation by ECG 1 month after surgery.Another child with AVNRT had another episode of SVT 8 months after surgery.5.A total of 4 children had complications,1 child with AVNRT had grade II type I AV block after surgery,1 child with para-HB AP had degree I AV block after surgery,and 2children with LAP had bleeding at the puncture point after surgery.There was no significant difference in complication rates between the AVNRT group and the AVRT group.There was no significant difference in complication rates between LAP group and RAP groups.There was no significant difference in the complication rate between the TS ablation group and the TA ablation group in the LAP group.None of the children developed serious complications such as cardiac perforation,cardiac tamponade and cardiogenic shock.6.The average operation time of the children was(92.7 ± 37.8)min,and the average operation time of the AVRT group was longer than that of the AVNRT group show [(98.6±40.8)min ratio(77.7±22.8)min].The mean operation time of the LAP group was longer than that of the RAP group show [(106.2±43.3)min ratio(86.6±33.0)min].The mean operation time of TS ablation group was(106.6±35.4)min and TA ablation group was(104.2 ± 44.7)min,and the difference between the two was not statistically significant.7.The average X-ray exposure time of the TA ablation group in the LAP group was greater than that of the TS ablation group show [(3.4±1.4)min ratio(2.4±0.9)min],and the average X-ray exposure dose in the TA ablation group was greater than that in the TS ablation group show [(16.6±5.6)m Gy ratio(12.5±3.8)m Gy].Conclusions: 1.Ensite Nav X system guided RFCA has good surgical efficacy and safety in the treatment of children’s PSVT.There is no obvious difference in the effect of ablation of PSVT caused by different mechanisms.The effect of medium and long-term follow-up is accurate.The characteristics of significantly reducing X-ray exposure during surgery are conducive to children’s growth and development and greatly reduce the harm caused by radiation to the health of medical staff,which have become the preferred method for radical treatment of children’s PSVT at home and abroad.2.LAP by TS ablation and TA ablation in children has high efficacy and safety,and the choice of the two ablation pathways depends on the accurate prediction of the AP position before surgery.The flexible selection of the ablation route according to the AP position and avoiding their respective shortcomings can effectively play their respective advantages.TS ablation is more effective than TA ablation in reducing radiation exposure in children and healthcare workers.And in some cases it will be the preferred ablation pathway,while proficiency in atrial septal puncture technique is the key to successful ablation.Ablation of special types of PSVT such as para-HB AP and AVNRT has a high risk of AV block.Being familiarity with cardiac electrophysiological anatomy,EPS techniques and proficiency in ablation procedures can effectively reduce complications. |
PDF Full Text Request