KT Wong, TC Yung, KS Lun, KYY Fan, AKT Chau

Abstract

Transcatheter radiofrequency ablation of supraventricular tachycardia was first introduced in 1987. The procedure is now well-accepted as primary treatment for supraventricular tachycardia in paediatric patients. In this report we describe our experience of radiofrequency ablation of accessory pathway mediated supraventricular tachycardia in the past 10 years. From 1994 to 2005, 121 procedures of radiofrequency ablation of accessory pathway were performed on 103 children and young adults aged 4.3 to 24.7 years. Ninety-three patients (90.3%) had one pathway and 10 (9.7%) had 2 pathways. Forty-four percent of all accessory pathways were associated with Wolff-Parkinson-White syndrome. There were 73 (65.2%) left-sided accessory pathways and 39 (34.8%) right-sided accessory pathways. One hundred and three (92%) accessory pathways were successfully ablated. Successful rate of left-sided accessory pathway ablation was higher than the right-sided accessory pathway (97.3% vs. 82.1%, p=0.005). Two patients (1.9%) developed major complications: one transient second degree and one permanent complete heart block who required permanent pacing. Recurrence after first successful radiofrequency ablation was 10.4% (9/86). Seventeen procedures (14%) were performed for failed first radiofrequency ablation or recurrence. On follow-up 90.3% of all patients remained asymptomatic. Our experience indicated that radiofrequency ablation is a safe and effective treatment for accessory pathway mediated supraventricular tachycardia in children and young adults.

1987 年第一次應用經導管射頻消融術治療室上性心動過速，這一方法目前已經公認為兒科室上性心動過速的主要治療手段。本文報導我們過去十年應用射頻消融術治療旁道介導室上性心動過速治療的經驗，從 1994 年到 2005 年對 121 例旁道病人進行射頻消融，包括 103 例兒童和年青人（4.3-24.7 歲）。本組病例中有 93 例（佔 90.3%）為一條旁道，有 10 例（佔 9.7%）為 2 條旁道；有 44% 伴有顯性預激綜合症（Wolff-Parkinson-White syndrome）；有 73 例（佔 65.2%）為左側旁道和 39 例（34.8%）為右側旁道。成功進行射頻消融有 103 例（佔 92%），發現左側旁道成功率高於右側旁道（為 97.3% 比 82.1%，p=0.005）；發生嚴重的併發症有 2 例（佔 1.9%）：一例是暫時的二度房室傳導阻滯，另一例為需要安裝永久起搏器的三度房室傳導阻滯。第一次成功進行射頻消融後復發為 10.4%（9/86），射頻消融未成功或者復發有 17 例（佔 14%），隨訪所有病例中 90.3% 病人無症狀。我們的經驗表明在兒童和青年人由旁道介導的室上性心動過速進行射頻消融是安全有效的治療手段。