| BackgroundTachyarrhythmia is a common type of arrhythmia in children.Continuous of frequent tachycardia has a risk of tachycardia induced cardiomyopathy.Conventional pharmacological therapy can't take the role of tachyarrythmia,while radiofrenquency catheter ablation(RFCA)has been widely used in adult patients due to its curative effect.But large sample clinical research in pediatric patients is still limited.ObjectiveProceed with the review analysis of clinical data of the pediatric patients with tachyarrhythmia after RFCA of our hospital.Understand the common types of tachyarrhythmia in children,and investigate the efficacy and safety of RFC A treatment for children with tachyarrhythmia of various types,and the complications occurrence.MethodCollected from January 2015 to August 2017 in Guangdong General Hospital heart underwent electrophysiological study and radiofrequency catheter ablation in 290 cases of children patients with tachyarrhythmia.We retrospectively evaluated their clinical characteristics,results of EPS,efficacy of RFCA,complications during the procedure and follow-up.ResultAmong the 290 patients,male 178 cases,female 112 cases,aged 2 months old to 18 years old.The average age was(9.85±3.37)years old.The average weight was(36.07± 14.15)kg.The operation time was 30 minutes to 180 minutes,and the average time was(76.43±25.85)minutes.X-ray exposure time was 1 minutes to 45 minutes,and the average time was(7.50 ±6.08)minutes.7 children associated with heart disease received RFCA successfully.4 cases had tachyarrhythmia associated with tachycardia induced cardiomyopathy.1 cases had ARVC.2.All the 290 patients were underwent electrophysiological study and radiofrequency catheter ablation,atrioventricular reentrant tachycardia(AVRT)in 139 cases,accounting for 47.93%of the total number of cases,which accounted for 51.08%of the left accessory pathway(71/139),right accessory accounted for 43.88%(61/139),double bypass cases accounted for 5.03%(7/139).There were 80 cases of atrioventricular nodal reentrant tachycardia(AVNRT),accounting for 27.59%of the total cases,59 cases of ventricular arrhythmia,accounting for 20.34%of the total cases,including 32 cases of ventricular premature beat(PVC)and 27 cases of ventricular tachycardia(VT).There were 12 cases of atrial arrhythmia,which accounted for 4.14%of the total cases,including 10 cases of atrial tachycardia(AT)and 2 cases of atrial fibrillation(AF).3.The total ablation successful rate was 96.2%(279/290).There were 2 cases of right accessory near HIS bundle.In order to prevent complications,we give up completely ablation.There were 1 cases of left atrioventricular accessory pathway.We give up the treatment considering high atrial septal puncture risks in early age children.The operation was completed in 1 cases of AVNRT children with I[AVB]during the operation.2 cases of children with AT were ablated repeatedly and still had episodes of atrial tachycardia.Considering the children's age,we give up complete ablation in order to prevent complications.5 cases of children with VT were repeatedly ablation,still PVC.Considering the children's age,we decided to give up ablation to prevent complications.4.Procedure-related complication rate was 2.76%in patients.AVB in 3 cases occurred for a short time during ablation.2 cases occurred injury of blood vessel,including femoral arteriovenous fistula and skin hematoma.1 case with mild pericardial effusion.lcase had left eye pain after ablation,and all recovered after treatment.There were no serious complications 5.The total ablation successful rate was 96.21%(279/290),in which left-side nor deaths of all the patients.accessory pathway was the highest with 98.59%,followed by AVNRT with 98.75%and VT with 91.52%.Lowest successful rate was AT(83.33%).There was no significant difference between AVRT and AVNRT(97.84%vs 98.75%).The number of dominance accessory pathway is significantly higher than that of concealed accessory pathway(p<0.001).Left accessory pathways is morc than right accessory pathway.6.The follow-up time was 3 months to 3 years,the mean follow-up time was(11.15±6.42)months.After the first successful radiofrequency catheter ablation 18 cases recurred,the recurrence rate was 6.21%(18/290),time to relapse was 2h-1y,and the average time was 5 months.There were 12 cases of AVRT(12/139,8.63%).There were 3 cases of VT(3/27,11.1%)and 2 cases of AT(2/10,20%).The recurrence rate of VT and AT children was significantly higher than that of AVRT and AVNRT.16 cases received the second successful RFCA,the successful rate was 93.75%(15/16).ConclusionRadio frequency catheter ablation can be a safe and effective therapy for pediatric tachyarrhythmia,as long as the indications and operation norms are strictly grasped. |
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