Hiệu quả điều trị tim nhanh trên thất bằng năng lượng có tần số radio ở trẻ nhỏ cân

The results of radiofrequency ablation in infants and small children with supraventricular tachycardia ĐẠI HỘI TIM MẠCH TOÀN QUỐC 22-14/10/2014 Trung tâm hội nghị quốc tế ICC

The results of radiofrequency ablation in

infants and small children with supraventricular tachycardia

ĐẠI HỘI TIM MẠCH TOÀN QUỐC

22-14/10/2014

Trung tâm hội nghị quốc tế ICC

Đà nẵng, Việt Nam

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

14

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

Radiofrequency Ablation (RFA) Role

1 An alternative to chronic antiarrhythmic drug

therapy

2 The standard therapy for SVT in adolescents with

symptomatic tachycardia

3 Infants and children < 4 year old or weight < 15

kg are independent risk factors for complications associated with RFA

Indian Pacing Electrophysiol J, 2005; 5(1): 51-62

RFA in Infants and Small Children

• Antiarrhythmic drug:

– The first-line treatment for small children

• Controversy about safety of RFA

– Previous study (Kugler et al, 1997): Infants and children < 4 year old or weight < 15 kg are independent risk factors for complications

associated with RFA

– Some recent studies show conflicting data

• Indication for RFA:

– Recurrent hemodynamically compromising drug-resistant SVT

– Tachycardia-induced dilated cardiomyopathy

Indian Pacing Electrophysiol J, 2005; 5(1): 51-62

Objective

• 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

Data analysis

 Using SPSS 22.0

• The chi-square method for categorical variables

• The t-test for continuous variables

• A p value of £ 0.05 was taken to denote a significant difference.

Results

Baseline patient characteristics

Electrophysiology study and

radiofrequency ablation data

Group I Group II p

Outcome of RFA

Group I Group II p

Guideline for Indication

Class I:

1 WPW syndrome following an episode of aborted sudden cardiac

death

2 WPW syndrome with syncope and

 Syncope short pre-excited RR interval during atrial fibrillation

(pre-excited R-R , 250 ms)

 Or the antegrade effective refractory period of the AP measured

during programmed electrical stimulation is , 250 ms

3 Chronic or recurrent SVT associated with ventricular

dysfunction.

PACE, 2002; 25: 1000-17

Guideline for Indication

Class IIa

1 Recurrent and/or symptomatic SVT refractory to

conventional medical therapy and age > 4 years

2 Impending congenital heart surgery when vascular or

chamber access may be restricted fol- lowing surgery

3 Chronic (occurring for 6–12 months following an initial event) or incessant SVT in the presence of normal

ventricular function

4 Chronic or frequent recurrences of intra-atrial reentrant

tachycardia

5 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

effective or associated with intolerable side effects

4 IART, one to three episodes per year, requiring medical

intervention

PACE, 2002; 25: 1000-17

Argument against RFA

1 Risk for major complication

2 Technical issues with RFA in small hearts

3 The potential unknown long-term effects

Indian Pacing Electrophysiol J, 2005; 5(1): 51-62

Argument in favour RFA

 Greater difficulties with medical management

 Higher rate of drug refractory therapy and side effect

during tachycardia in infants with CHD

Un- effective communication, the children

become more seriously ill

Indian Pacing Electrophysiol J, 2005; 5(1): 51-62

Pediatric Radiofrequency Ablation

(RFCA) Registry Data

( Including 4135 pts (0-21 year old)

Body weight < 15kg: the risk of major complication

Am J Cardiol, 1997; 80(11): 1438-43

( 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 (2004)

Aiyagari et

al (2005)

Akdeniz et

al (2013)

An et al (2013)

Hai et al (2014)

old)

< 15

Acute success

rate

different

94.4

Major

complication

2 (Pericardial perfusion, myocardial infarction )

2 (atrial perforation s)

Conclusion

RFA may be safe and reliable with good success rate

Thank you