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

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 months of life, 2nd peaks at 8-10 and in adolescense Indian Pacing Electrophysiol J, 2005; 5(1): 51-62 Radiofrequency Ablation (RFA) Role An alternative to chronic antiarrhythmic drug therapy The standard therapy for SVT in adolescents with symptomatic tachycardia Infants and children < 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 < 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 days of the ablation procedure and no AV Block during follow-up • Clinical follow-up: – 1, 3, and every 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 Group I Group II P Age (years; mean ± SD) 2.2±1.4 8.6±2.9 < 0.001 Weight (kg; mean ± SD) 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 Electrophysiology study and radiofrequency ablation data Group I Group II p Substrate Ablation (% left-sided) 36.8 35.0 0.089 Tachycardia mechanism (% AVRT) 88.9 67.6 0.089 275 ± 35 319 ± 53 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 Total procedure time (min) 102 ± 35 109 ± 37 0.672 Cycle length (ms) No of RFA applications RFA total time (sec) Outcome of RFA Group I Group II p 7.7 ± 5.6 11.3 ± 6.5 0.03 Acute success rate (%) 94.4 90 0.08 Recurrence rate (%) 11.8 21.6 0.01 Follow-Up (manths) No of major complication No of dead Guideline for Indication Class I: WPW syndrome following an episode of aborted sudden cardiac death WPW syndrome with syncope and   Syncope short pre-excited RR interval during atrial fibrillation (preexcited R-R , 250 ms) Or the antegrade effective refractory period of the AP measured during programmed electrical stimulation is , 250 ms Chronic or recurrent SVT associated with ventricular dysfunction PACE, 2002; 25: 1000-17 Guideline for Indication Class IIa Recurrent and/or symptomatic SVT refractory to conventional medical therapy and age > years Impending congenital heart surgery when vascular or 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: Asymptomatic WPW w/ age >5 years, with no recognized tachycardia, when the risks and benefits of the procedure and arrhythmia have been clearly explained SVT, age >5 years, as an alternative to chronic antiarrhythmic therapy which has been effective in control of the arrhythmia SVT, age < years, when antiarrhythmic medications are not effective or associated with intolerable side effects IART, one to three episodes per year, requiring medical intervention PACE, 2002; 25: 1000-17 Argument against RFA Risk for major complication Technical issues with RFA in small hearts 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  The higher risk for hemodynamic compromise 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 • 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 24 18 Weight (kg) [...]... syncope and   3 Syncope short pre-excited RR interval during atrial fibrillation (preexcited R-R , 250 ms) Or the antegrade effective refractory period of the AP measured during programmed electrical stimulation is , 250 ms Chronic or recurrent SVT associated with ventricular dysfunction PACE, 2002; 25: 1000-17 Guideline for Indication Class IIa 1 2 3 4 5 Recurrent and/or symptomatic SVT refractory... risk for hemodynamic compromise 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 • 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):