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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
02. Clinical Skills
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
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26. Cardiovascular Surgery
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Population-based single-centre outcome for catheter ablation of paediatric cardiac arrhtyhmias
Session:
Posters 1 - Écran 5 - Congénitos
Speaker:
Sergio Matoso Laranjo
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.7 Pediatric Cardiology
Session Type:
Posters
FP Number:
---
Authors:
Sérgio Laranjo; Mário Martins Oliveira; Ana Sofia Delgado; Nuno Monteiro; Conceição Trigo; Maria De Fátima Pinto
Abstract
<p>Catheter ablation is an effective alternative in the treatment of a variety of arrhythmias. However, in children and adolescents, arrhythmias and their causes have particular characteristics and long-term follow-up data are still inconsistent. The aim of the present study is to analyse the long-term results of percutaneous catheter ablation in a paediatric population.<br /> <br /> Methods: Retrospective, observational, single-centre study of patients (P) aged <18 years submitted to electrophysiological study and ablation between January 2000 and September 2018. Demographic data, presence of structural heart disease, type of energy used, immediate and long-term success rate and late complications were collected.<br /> <br /> Results: 285 ablations were performed in 241P with 13.0 ± 3.3 years (4-17 years), 56.8% were male. The most frequent indications were: atrioventricular re-entrant tachycardia (AVRT) in 60% (48% with right accessory pathways (AP)), 20.6% with nodal reentrant tachycardia (AVNRT), 10% atrial tachycardia (AT) and ventricular extrasystoles/ventricular tachycardia in 4%. Ten P (4%) had lone paroxysmal AF. 34P (16%) had congenital heart disease, mainly Ebstein’s disease and surgically corrected tetralogy of Fallot. Immediate success rate for AP was 94% (90% in the right AP and 99% in the left-sided AP), and it was necessary to repeat the procedure in 15% of the cases (maximum of 3 procedures/P), mostly in P with right-sided AP, with a long-term success rate of 96% after repeat procedure. For AVNRT, immediate success was 96.1%, and long-term of 98 % after repeat procedure. For AT, 86% of long-term success was obtained. The ablation was performed through transeptal puncture in 25% of cases. Cryoenergy was used in 12 cases with parahisian AP (immediate success rate of 95%, long term 78%). A total of 82 RF procedures were performed using a limited fluoroscopic approach based on 3D mapping system. Procedural and mean fluoroscopy times decreased in this group as compared to the historical cohort: 82.5±49 min vs. 170.3±66.7 min (p<0.001) and 1.8±2.1 min vs. 11.8±14 min (p<0.001), respectively, with a significant reduction of the mean fluoroscopy time occurring in the last quartile of the limited fluoroscopy cohort [3.5±2.9 to 1.0±0.8 min (p<0.05), mainly for transeptal puncture. Acute success rate was 98% in the limited fluoroscopy group and 95%in the historical cohort (p=NS). In AP ablation, the comparison between strategies showed an increase from 90% to 98.7% (after 2015, limited fluoroscopy) (p<0.05). There were no major complications, namely AV block, pacemaker need or cardiac tamponade. <br /> <br /> Conclusions: Percutaneous ablation is an effective and safe procedure and is an eligible treatment for most paediatric tachyarrhythmias that are refractory to medical therapy. SVT based on a 3D mapping system using very limited fluoroscopy can be safe and highly successful in children, without any complication.</p>
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