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Evaluation der Ablationsergebnisse von supraventrikulären Tachykardien durch angeborene Substrate bei Kindern mit angeborenen Herzfehlern im Vergleich zu Kindern ohne Herzfehler

Evaluation of the success of catheter ablation for supraventricular tachycardia in children with congenital heart disease compared to those children with structurally normal hearts

Matthies, Sebastian
Dissertation
Angenommen am: 2015-06-24
Erschienen: 2015-06-15
Betreuer: Paul, Thomas Prof. Dr.
Gutachter: Meyer, Thomas Prof. Dr.
Gutachter: Ruschewski, Wolfgang Prof. Dr.
Gutachter: Edelmann, Frank PD Dr.

Zum Verlinken/Zitieren: http://hdl.handle.net/11858/00-1735-0000-0022-601E-1

 

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Englisch

Already at the beginning of the 90s of the last century, electrophysiologic therapeutic catheterization widely replaced the surgical treatment of arrhythmias. The efficacy and safety of radiofrequency catheter ablation have been evidenced on the basis of a large number of pediatric patients with supraventricular tachycardias. The objective of this doctoral thesis was to determine the success of pediatric radiofrequency catheter ablation in infants and adolescents with atrioventricular (nodal) reentrant tachycardia using the modern non-fluoroscopic navigation system Loca Lisa in the children`s hospital of the Georg-August-University of Göttingen from October 2002 to December 2006. Cryoenergy was used as an alternative energy form due to its high safety and its specific features such as cryoadherence and cryomapping. A total of 145 consecutive children with a mean age of 11.1 ± 6.4 years including 24 children with a congenital heart defect (16.6%) had an electrophysiological study with catheter ablation. Eighty-two of them had a supraventricular tachycardia with one or more accessory pathways. Atrioventricular nodal reentrant tachycardia was detected in 56 children, of whom 7 patients have one or more accessory pathways additionally. A successful ablation of the tachycardia substrate was accomplished in 94.5% of the patients (137 out of 145). In 93.3% of the children with accessory pathway, a permanent disruption of the pathway was achieved. The overall success rate was 96.8% for children with atrioventricular nodal reentrant tachycardia. In three out of eight children for whom ablation failed, energy application was abstained due to increased risk of induction of an AV block. The mean duration of electrophysiological study was 226 minutes with a range from 105 minutes to 459 minutes. The median of the fluoroscopy time was 16 minutes (range: 4.2 – 71 minutes). In three children, there were major complications including high-grade AV. After a mean follow-up of 20.3 ± 14.7 months recurrence was observed in 13 of 137 children. This correlates to an incidence of 9.5%. Success rate, complications and recurrence were not significantly different between children with and without congenital heart defect. For children with congenital heart defects, the duration of the electrophysiological study and the fluoroscopy time were significantly longer compared to the group without heart defects (270 ± 86.7 minutes and 25.3 ± 10.7 minutes vs. 219 ± 69 minutes and 18.3 ± 11.6 minutes; p < 0.05 and p < 0.01). Children aged younger or older than five years were not significantly different with respect to treatment outcome. By using the modern nonfluoroscopic navigation system Loca Lisa, catheter ablation was safe and effective. The progress of the last years has made catheter ablation of supraventricular tachycardia in children with congenital heart defects an approved treatment option.
Keywords: Supraventricular tachycardia; Catheter ablation; Congenital heart disease; Children
Schlagwörter: Supraventrikuläre Tachykardien; Katheterablation; Angeborene Herzfehler; Kinder
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