Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지

Results of radiofrequency catheter ablation in children and adolescent with tachyarrhythmia

소아 청소년 부정맥 환자에서 고주파 전극도자 절제술의 이용 성적

  • Chang, Young Beom (Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School) ;
  • Lee, Seung Hyun (Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School) ;
  • Kang, Eun Young (Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School) ;
  • Rhee, Kyoung-Suk (Department of Internal Medicine, Institute of Cardiovascular Research, Chonbuk National University Medical School) ;
  • Joo, Chan Uhng (Department of Pediatrics, Institute of Cardiovascular Research, Chonbuk National University Medical School)
  • 장영범 (전북대학교 의과대학 소아과학교실, 심혈관연구소) ;
  • 이승현 (전북대학교 의과대학 소아과학교실, 심혈관연구소) ;
  • 강은영 (전북대학교 의과대학 소아과학교실, 심혈관연구소) ;
  • 이경석 (전북대학교 의과대학 순환기내과학교실, 심혈관연구소) ;
  • 주찬웅 (전북대학교 의과대학 소아과학교실, 심혈관연구소)
  • Received : 2007.09.04
  • Accepted : 2007.10.26
  • Published : 2007.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Radiofrequency catheter ablation (RFCA) has become an effective therapeutic modality for treating pediatric tachyarrhythmias. Using conventional RFCA catheters, ablation of parahisian accessory pathways may be difficult and have high risk for heart block. We reviewed the efficacy and complications of the RFCA in children and adolescent with arrhythmias including parahisian accessory pathways. Methods : We studied 48 patients (aged 2 years to 20 years) who had undergone RFCA from August 2003 to March 2007. We reviewed clinical findings, electrophysiologic studies, RFCA data, complications, and follow-up results of the patients. Results : Mean age of the patients was 13.1 years. Numbers and types of arrhythmias (age, acute success rate) were as follows: 19 WPW syndrome including 5 parahisian accessory pathways ($13.7{\pm}4.6yr$, 18/19), 11 atrioventricular reentrant tachycardia with concealed bypass tract ($12.3{\pm}5.0yr$, 10/11), 13 atrioventricular nodal reentrant tachycardia ($12.6{\pm}4.4yr$, 13/13), 4 atrial flutter ($13.0{\pm}7.4yr$, 3/4), and 1 ventricular tachycardia (20 yr, 1/1). Associated cardiac structural lesion was not detected in 48 patients. The recurrence rate was 6.5%, and the final success rate was 93.8%. Conclusion : These results suggest that RFCA is a highly effective treatment method in children and adolescent with tachyarrhythmia.

목 적 : 소아 부정맥의 치료에 고주파 전극도자 절제술 이용의 결과들이 보고되고 있다. 본 연구에서는 parahisian 부전도로 기전을 포함한 빈맥을 가진 소아 청소년 부정맥 환자에 대해 전기생리 검사와 함께 고주파 전극도자 절제술을 시행하고 그 결과와 추적 소견을 보고자 하였다. 방 법 : 2003년 8월부터 2007년 3월까지 전북대학교병원에서 고주파 전극도자 절제술을 시행 받은 48명의 소아 및 청소년 환자(연령 분포 : 2-20세, 평균 $13.1{\pm}4.8$년)를 대상으로 부정맥의 유형 및 기전, 총 시술시간, 단기 성공률, 재발율, 합병증 등에 대해 분석하였다. 결 과 : 고주파 전극도자 절제술을 받은 총 48례 소아 청소년 부정맥 환자에서, 부정맥의 유형은 parahisian 부전도로 5례를 포함한 WPW 증후군 19례(평균 연령 $13.7{\pm}4.6$년), 방실회귀 빈맥 11례($12.3{\pm}5.0$년), 방실결절회귀 빈맥 13례($12.6{\pm}4.4$년), 심방 조동 4례($13.0{\pm}7.4$년)과 심실 빈맥 1례였다. 시술 전 증상으로는 심계 항진이 가장 많았고(43례), 어지러움, 흉부통증 및 답답함 등의 증상성 빈맥에 따른 환자의 선택이 많았으며 무증상이었지만 부모의 선택에 의한 시술도 3례 있었다. 대상 증례 모두에서 기저 심질환은 없었다. 고주파 전극도자 절제술시 평균 $5.8{\pm}4.1$회의 고주파 전류 전달이 필요하였고, 총 시술시간은 준비시간을 포함하여 평균 $113.8{\pm}45.0$분이었다. 30례 방실회귀 빈맥 환자에서 부전도로의 위치로는 좌측 방실륜과 우심에 같은 빈도로 위치하였는데 국소 위치로는 좌심의 측벽(13례)과 우심의 전중격과 후중격 (각각 5례)에 위치한 순서였다. 대상 48명의 환아 중 2명을 제외하고 초기 시술 성공률(95.8%)을 보였고, 평균 16.4개월(2개월-4.5년) 추적 기간 동안 3례에서 부정맥의 재발을 보였고(재발율 6.5%), 재발한 증례 중 두 증례는 재시술로 치료되어 최종 치료 성공률은 93.8%였다. 시술 합병증으로는 부정맥이 재발했던 증례에서 시술 후 우측 대퇴정맥의 폐쇄와 parahisian 부전도로 절제 시술 후 우각차단 소견을 보인 증례를 제외하고 시술과 관련된 다른 합병증은 없었다. 결 론 : 본 연구를 통해 소아청소년기의 상실성 빈맥 등 부정맥 치료에 고주파 전극도자 절제술이 효과적이고 안전하게 시행될 수 있음을 보고하는 바이다.

Keywords

Acknowledgement

Supported by : 전북대학교

References

  1. Bae EJ, Ban JE, Lee JA, Jin SM, Noh CI, Choi JY, et al. Pediatric radiofrequency catheter ablation: results of initial 100 consecutive cases including congenital heart anomalies. J Korean Med Sci 2005;20:740-6 https://doi.org/10.3346/jkms.2005.20.5.740
  2. Ko JK, Park IS, Kim YH, Hong CY, Kim JJ. Early results of radio frequency catheter ablation of supraventricular tachycardia in children. J Korean Pediatr Soc 1997;40:1258-64
  3. Lee SJ, Jung MJ, Kim SH, Schueller WC, Kim GH, Lee HS. Treatment of tachycardia by radiofrequency catheter ablation in children and adolescents. J Korean Pediatr Soc 2000;43:210-5
  4. Kugler JD, Danford DA, Houston K, Felix G. Radiofrequency catheter ablation for paroxysmal supraventricular tachycardia in children and adolescents without structural heart disease. Pediatric EP Society, Radiofrequency Catheter Ablation Registry. Am J Cardiol 1997;80:1438-43 https://doi.org/10.1016/S0002-9149(97)00736-4
  5. Bauersfeld U, Pfammatter JP, Jaeggi E. Treatment of supraventricular tachycardias in the new millennium-drugs or radio frequency catheter ablation? Eur J Pediatr 2001; 160:1-9 https://doi.org/10.1007/PL00008409
  6. Pfammatter JP, Stocker FP. Results of a restrictive use of antiarrhythmic drugs in the chronic treatment of atrioventricular reentrant tachycardias in infancy and childhood. Am J Cardiol 1998;82:72-5
  7. Haissaguerre M, Marcus F, Poquet F, Gencel L, Le Metayer P, Clementy J. Electrocardiographic characteristics and catheter ablation of parahissian accessory pathways. Circulation 1994;90:1124-8 https://doi.org/10.1161/01.CIR.90.3.1124
  8. Lowe MD, Meara M, Mason J, Grace AA, Murgatroyd FD. Catheter cryoablation of supraventricular arrhythmias: a painless alternative to radiofrequency energy. Pacing Clin Electrophysiol 2003;26:500-3 https://doi.org/10.1046/j.1460-9592.2003.00081.x
  9. Papez AL, Al-Ahdab M, Dick M, Fischbach PS. Transcatheter cryotherapy for the treatment of supraventricular tachyarrhythmias in children: a single center experience. J Interv Card Electrophysiol 2006;15:191-6 https://doi.org/10.1007/s10840-006-9012-x
  10. Ernst S, Hachiya H, Chun JK, Ouyang F. Remote catheter ablation of parahisian accessory pathways using a novel magnetic navigation system-a report of two cases. J Cardiovasc Electrophysiol 2005;16:659-62 https://doi.org/10.1111/j.1540-8167.2005.40317.x
  11. Paul T, Bertram H, Bokenkamp R, Hausdorf G. Supraventricular tachycardia in infants, children and adolescents: diagnosis, and pharmacological and interventional therapy. Paediatr Drugs 2000;2:171-81 https://doi.org/10.2165/00128072-200002030-00002
  12. Ko JK, Ban JE, Kim YH, Park IS. Long-term efficacy of atenolol for atrioventricular reciprocating tachycardia in children less than 5 years old. Pediatr Cardiol 2004;25:97-101 https://doi.org/10.1007/s00246-003-0536-x
  13. Bink-Boelkens MT. Pharmacologic management of arrhythmias. Pediatr Cardiol 2000;21:508-15 https://doi.org/10.1007/s002460010128
  14. Ko JK, Park IS, Kim YH, Hong CY, Kim JJ, Kim YH. Catheter ablation of atrial flutter using radio frequency energy in a child: a case report. J Korean Pediatr Soc 1996;39: 1455-60
  15. Ko JK, Deal BJ, Strasburger JF, Benson DW Jr. Supraventricular mechanisms and their age distribution in pediatric patients. Am J Cardiol 1992;69:1028-32 https://doi.org/10.1016/0002-9149(92)90858-V
  16. Weindling SN, Saul JP, Walsh EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. Am Heart J 1996;131:66-72 https://doi.org/10.1016/S0002-8703(96)90052-6
  17. Collins KK, Love BA, Walsh EP, Saul JP, Epstein MR, Triedman JK. Location of acutely successful radiofrequency catheter ablation of intraatrial reentrant tachycardia in patients with congenital heart disease. Am J Cardiol 2000; 86:969-74 https://doi.org/10.1016/S0002-9149(00)01132-2
  18. Epstein MR, Saul JP, Weindling SN, Triedman JK, Walsh EP. Atrioventricular reciprocating tachycardia involving twin atrioventricular nodes in patients with complex congenital heart disease. J Cardiovasc Electrophysiol 2001;12:671-9 https://doi.org/10.1046/j.1540-8167.2001.00671.x
  19. Calkins H, Niklason L, Sousa J, el-Atassi R, Langberg J. Morady F. Radiation exposure during radiofrequency catheter ablation of accessory atrioventricular connections. Circulation 1991;84:2376-82 https://doi.org/10.1161/01.CIR.84.6.2376
  20. Geise RA, Peters NE, Dunnigan A, Milstein S. Radiation doses during pediatric radiofrequency catheter ablation procedures. Pacing Clin Electrophysiol 1996;19:1605-11 https://doi.org/10.1111/j.1540-8159.1996.tb03187.x
  21. Kugler JD, Danford DA, Houston KA, Felix G. Pediatric radiofrequency catheter ablation registry success, fluoroscopy time, and complication rate for supraventricular tachycardia: comparison of early and recent eras. J Cardiovasc Electrophysiol 2002;13:336-41 https://doi.org/10.1046/j.1540-8167.2002.00336.x
  22. Van Hare GF, Witherell CL, Lesh MD. Follow-up of radiofrequency catheter ablation in children: results in 100 consecutive patients. J Am Coll Cardiol 1994;23:1651-9 https://doi.org/10.1016/0735-1097(94)90670-X
  23. Kobza R, Kottkamp H, Piorkowski C, Tanner H, Schirdewahn P, Dorszewski A, et al. Radiofrequency ablation of accessory pathways. Contemporary success rates and complications in 323 patients. Z Kardiol 2005;94:193-9 https://doi.org/10.1007/s00392-005-0202-9