Cryotherapy ablation of parahisian accessory pathways in children
| Autor: | Elchanan Bruckheimer, Einat Birk, Joel A. Kirsh, Moshe Swissa, Tom Einbinder, Ilan Goldenberg, Robert Klempfner, Michal Fogelman, Rami Fogelman, Tamir Dagan |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment Operative Time Cryotherapy Accessory pathway Cryosurgery Recurrence Physiology (medical) Humans Medicine Fluoroscopy Israel Child Retrospective Studies Intraoperative Care medicine.diagnostic_test business.industry Cryoablation Right bundle branch block medicine.disease Ablation Accessory Atrioventricular Bundle Surgery Treatment Outcome Echocardiography Female Wolff-Parkinson-White Syndrome Supraventricular tachycardia Electrophysiologic Techniques Cardiac Cardiology and Cardiovascular Medicine business Atrioventricular block Follow-Up Studies |
| Zdroj: | Heart Rhythm. 12:917-925 |
| ISSN: | 1547-5271 |
| Popis: | Because of its safety profile, cryoablation has become an alternative therapy for septal arrhythmias, including parahisian accessory pathways (APs). Data regarding its efficacy, safety, and late outcome for parahisian APs in children are limited.The purpose of this study was to evaluate the safety and efficacy of cryoablation of parahisian APs in children.Fifty-nine cryoablations of parahisian APs were performed in 50 patients [76% males; median age 16.5 years (range 5.3-20 years)]. Thirty-three had manifest APs and 17 had concealed APs. The time to effect was defined as the duration of time from reaching -30°C to the disappearance of AP during the cryomapping phase. The acute success rate for the first ablation was 94% (47/50).Mean fluoroscopy time and number of cryoablations were 28.5 ± 23.3 minutes and 2.6 ± 1.2 seconds, respectively. The time to effect was 8.5 ± 7.1 seconds. The overall recurrence rate was 14.9%, decreasing from 40% in the first 10 cases to 8.1% in the next 37 (P.02). Multivariate analysis showed that the only independent predictor for recurrence rate was time to effect10 seconds (P.001). A high recurrence rate was also associated with concealed APs and ablation during supraventricular tachycardia (P.03 and P.05, respectively). The patients who had recurrence underwent a second successful cryoablation. During median follow-up of 59.7 months (range 6-102 months), a long-term success rate of 94% was achieved. No permanent ablation-related complications occurred.Cryoablation of parahisian APs has excellent short- and long-term efficacy and safety profile. Increased physician experience is associated with a reduced recurrence rate. |
| Databáze: | OpenAIRE |
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