Ριζική θεραπεία υπερκοιλιακών ταχυκαρδιών στα παιδιά με ρεύμα ραδιοσυχνότητας

Abstract

Background: Supraventricular tachycardia (SVT) represents a significant cause of morbidity in children. Because of the chronic course, long-term treatment with antiarrythmic drugs is not an ideal solution. Radiofrequency ablation (RFA) may offer curative treatment. Purpose: The purpose of this study was to analyze the outcome of radiofrequency ablation (RFA) of supraventricular tachycardia (SVT) in children. Methodology: We reviewed retrospectively the charts of 140 patients (pts) 4-18 (12,8±3,5) years of age, who underwent complete electrophysiologic study and RFA., either under general anesthesia (84), or conscious sedation (56). Results: The final success of RFA, after possible recurrences, was 90/94 (95,7%) for pts with accessory pathways (AP), 36/37 (97,3%) for pts with AV nodal reentry tachycardia (AVNRT), 10/10 for pts with ectopic atrial tachycardia, 3/3 for pts with atrial reentry tachycardia, and 1/1 for a pt with junctional ectopic tachycardia. Longer fluoroscopy time (p=0,05) and lower final success (p=0,02) was observed in pts with anterior/mid-septal AP. The remaining categories had comparable results. Patients with right lateral AP had a higher prevalence of congenital heart disease (p<0,001). Recurrences were more frequent in pts with multiple AP (p=0,007). The incidence of severe permanent complications was 1,4% (1 pt with aortic insufficiency after retrograde RFA of left lateral AP, and 1 pt with complete AV block after RFA of AVNRT). The final success, recurrence rates and complication rates were independent of age. Conclusions: Treatment of SVT in children with RFA may offer permanent cure, without differences in outcomes in pts older than 4 years of age.