22-14/10/2014

14

ĐẠI HỘI
TIM MẠCH TOÀN QUỐC

Trung tâm hội nghị quốc tế ICC

Đà nẵng, Việt Nam

The results of radiofrequency ablation in
infants and small children with
supraventricular tachycardia
Nguyen Thanh Hai, MD*; Quach Tien Bang, MD*;
Tran Quoc Hoan*; Pham Nhu Hung,MD, PhD**
*National Hospital of Pediatrics
**National Heart Institute, Bach Mai Hospital


Introduction
Supraventricular Tachycardia (SVT):
Most common abnormal tachycardia seen in
pediatric practice (Incidence up to 1:250 children)

Most common arrhythmia requiring treatment in
pediatric population

Most frequent age presentation: 1st 3 months of life,
2nd peaks at 8-10 and in adolescense
Indian Pacing Electrophysiol J, 2005; 5(1): 51-62.

• To evaluate the efficacy and safety of RCA in
infants and small children


Method
• Retrospective study
• Eligible patients:
– All pts underwent RFA for SVT in NHP
• Group I: Pts ≤ 15 kg
• Group II: Pts > 15 kg
– From Aug 2012 to Aug 2014

• Recorded patient data


Method
• Primary endpoints:
• Acute procedural success
– Absence of tachycardia or pre-excitation for 24 hours after RFA

• Chronic success
– Acute procedural success and freedom of tachycardia symtoms during
follow-up.

• Procedural safety
– Absence of serious complications associated with RFA within 2 days of the
ablation procedure and no AV Block during follow-up

• Clinical follow-up:
– 1, 3, and every 6 months after procedure


11.1±3.0

28.1±8.4

< 0.001

Gender (%Nam)

55.6

62.2

0.6

Structral heart Diseases (%)

22.2

2.7

0.03

EKG with manifest WPW

72.2

42.2

0.04

0.002

17.1 ± 12.4

17.7 ± 16.2

0.882

263 ± 132

346 ± 288

0.148

Fluo Time (min)

32.1 ± 18.4

23.0 ± 18.9

0.093

RFA maximum temperature (C)

55.5 ± 6.3

56.2 ± 6.6

0.581


90

0.08

Recurrence rate (%)

11.8

21.6

0.01

Follow-Up (manths)

No. of major complication

0

No. of dead

0


Guideline for Indication

Class I:
1.

WPW syndrome following an episode of aborted sudden cardiac
death.

chamber access may be restricted fol- lowing surgery
Chronic (occurring for . 6–12 months following an initial
event) or incessant SVT in the presence of normal
ventricular function
Chronic or frequent recurrences of intra-atrial reentrant
tachycardia.
Palpitations with inducible sustained SVT during
electrophysiological testing.
PACE, 2002; 25: 1000-17


Guideline for Indication
Class IIb:
1.

Asymptomatic WPW w/ age >5 years, with no recognized
tachycardia, when the risks and benefits of the procedure and
arrhythmia have been clearly explained.

2.

SVT, age >5 years, as an alternative to chronic antiarrhythmic
therapy which has been effective in control of the arrhythmia.

3.

SVT, age < 5 years, when antiarrhythmic medications are not
effective or associated with intolerable side effects.

4.

(RFCA) Registry Data
• Kugler et all (1997), data from 1991–1997
( Including 4135 pts (0-21 year old)
Body weight < 15kg: the risk of major complication
Am J Cardiol, 1997; 80(11): 1438-43

• Blaufox et al (2001), data from 1989–1999
( Including 137 infants < 15 kg vs 5960 older children)
–No significant differences were found for complication and success rates
between infants and noninfants
Circulation 2001; 104(23):2803-8


Single center outcome of RFA
Blaufox et al Aiyagari et
(2004)
al (2005)

Akdeniz et An et al
al (2013)
(2013)

Hai et al
(2014)

No. of pts

12

25

4/5

Recurrence rate

11.8

Major
complication

2
(Pericardial
perfusion,
myocardial
infarction
)

2 (atrial
perforation
s)

Dead

No

No

NG

No