Utility of Echocardiography in Detecting Silent Complications After Pediatric Catheter Ablations

作者：Amdani Shahnawaz M^*; Sallaam Salaam; Karpawich Peter P; Aggarwal Sanjeev

来源：Pediatric Cardiology, 2017, 38(7): 1426-1433.

DOI：10.1007/s00246-017-1680-z

• Echocardiogram
• Supraventricular tachycardia (SVT)
• Atrioventricular reentrant tachycardia (AVRT)
• Atrioventricular nodal reentrant tachycardia (AVNRT)
• Radiofrequency ablation
• Cryoablation
• Pericardial effusion
• Valvular regurgitation
• Ventricular function

Although transcatheter arrhythmia ablation (TCA) has been performed in children for over two decades, guidelines for routine use of post-ablation transthoracic echocardiography (TTE) are absent. We sought to determine the efficacy of TTE after apparently uneventful TCA procedures in detecting adverse findings and identify predisposing factors. A retrospective review of clinical and procedural data on patients who underwent TCA for supraventricular arrhythmias from 2000 to 2015 was performed. Pre- and post-ablation TTE data were reviewed. All patients were followed at 1 week, 6 and 12 months post-TCA. A repeat TTE was performed at 12 months on patients in whom post-TCA abnormalities were found. Patients were divided into two groups: those with and without adverse TTE findings and comparative analysis between variables was performed. Data on 252 patients, 52% males, mean age 14 +/- 3 years were analyzed. New onset or worsening atrioventricular valve regurgitation occurred in 17 (6.7%), a small pericardial effusion in 3 (1.2%) and worsened ventricular function in 2 patients (0.8%). Patients in the complication group had higher mean number of ablations (22.6 +/- 15.3 vs. 16.8 +/- 9.2, p 0.001) and required longer duration of ablation (sec) (254.6 +/- 256.4 vs. 180.9 +/- 158.9, p < 0.001). TCA location (including coronary sinus), energy source, arrhythmia substrate, and a trans-septal approach were noncontributory to any adverse findings. Routine post-ablation TTE uncovers asymptomatic self-resolving abnormalities that typically do not require any intervention.

• 出版日期2017-10