Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica

Risultati immediati e di un follow-up a medio termine

Translated title of the contribution: Transcatheter radiofrequency ablation of supraventricular tachycardia in children: Early results and mid-term follow-up

Annibale Sandro Montenero, Fabrizio Drago, Filippo Crea, Carmelita Varano, Sergio Guarneri, Adriano Cipriani, Gemma Pelargonio, Domenico Antonio Agostino, Fulvio Bellocci, Pietro Ragonese, Paolo Zecchi

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVES. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS. Forty-six pediatric patients (mean age 12.6 years, range 3-18 ) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS. To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transeptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS. Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6%). Mean fluoroscopy time was 31 ± 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 ± 10 min and with transeptal 23 ± 12 min (p <0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50%). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100% in patients with an accessory pathway and 33% in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. Complications: Major complications (6,5%) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS. Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.

Original languageItalian
Pages (from-to)31-40
Number of pages10
JournalGiornale Italiano di Cardiologia
Volume26
Issue number1
Publication statusPublished - Jan 1996

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Supraventricular Tachycardia
Reciprocating Tachycardia
Tachycardia
Atrioventricular Node
Fluoroscopy
Pediatrics
Ambulatory Electrocardiography
Femoral Vein
Ventricular Tachycardia
Hematoma
Cicatrix
Pulse
Cardiac Arrhythmias
Electrocardiography
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica : Risultati immediati e di un follow-up a medio termine. / Montenero, Annibale Sandro; Drago, Fabrizio; Crea, Filippo; Varano, Carmelita; Guarneri, Sergio; Cipriani, Adriano; Pelargonio, Gemma; Agostino, Domenico Antonio; Bellocci, Fulvio; Ragonese, Pietro; Zecchi, Paolo.

In: Giornale Italiano di Cardiologia, Vol. 26, No. 1, 01.1996, p. 31-40.

Research output: Contribution to journalArticle

Montenero, AS, Drago, F, Crea, F, Varano, C, Guarneri, S, Cipriani, A, Pelargonio, G, Agostino, DA, Bellocci, F, Ragonese, P & Zecchi, P 1996, 'Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica: Risultati immediati e di un follow-up a medio termine', Giornale Italiano di Cardiologia, vol. 26, no. 1, pp. 31-40.
Montenero, Annibale Sandro ; Drago, Fabrizio ; Crea, Filippo ; Varano, Carmelita ; Guarneri, Sergio ; Cipriani, Adriano ; Pelargonio, Gemma ; Agostino, Domenico Antonio ; Bellocci, Fulvio ; Ragonese, Pietro ; Zecchi, Paolo. / Ablazione transcatetere con radiofrequenza delle tachicardie sopraventricolari in età pediatrica : Risultati immediati e di un follow-up a medio termine. In: Giornale Italiano di Cardiologia. 1996 ; Vol. 26, No. 1. pp. 31-40.
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abstract = "OBJECTIVES. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS. Forty-six pediatric patients (mean age 12.6 years, range 3-18 ) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS. To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transeptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS. Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6{\%}). Mean fluoroscopy time was 31 ± 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 ± 10 min and with transeptal 23 ± 12 min (p <0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50{\%}). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100{\%} in patients with an accessory pathway and 33{\%} in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. Complications: Major complications (6,5{\%}) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS. Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.",
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T2 - Risultati immediati e di un follow-up a medio termine

AU - Montenero, Annibale Sandro

AU - Drago, Fabrizio

AU - Crea, Filippo

AU - Varano, Carmelita

AU - Guarneri, Sergio

AU - Cipriani, Adriano

AU - Pelargonio, Gemma

AU - Agostino, Domenico Antonio

AU - Bellocci, Fulvio

AU - Ragonese, Pietro

AU - Zecchi, Paolo

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N2 - OBJECTIVES. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS. Forty-six pediatric patients (mean age 12.6 years, range 3-18 ) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS. To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transeptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS. Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6%). Mean fluoroscopy time was 31 ± 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 ± 10 min and with transeptal 23 ± 12 min (p <0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50%). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100% in patients with an accessory pathway and 33% in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. Complications: Major complications (6,5%) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS. Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.

AB - OBJECTIVES. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS. Forty-six pediatric patients (mean age 12.6 years, range 3-18 ) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS. To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transeptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS. Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6%). Mean fluoroscopy time was 31 ± 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 ± 10 min and with transeptal 23 ± 12 min (p <0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50%). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100% in patients with an accessory pathway and 33% in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. Complications: Major complications (6,5%) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS. Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.

KW - Ablation

KW - Children

KW - Radiofrequency

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