Background

Cryoablation is increasingly used to treat atrioventricular nodal reentrant tachycardia (AVNRT) due to its safety profile. However, cryoablation may have higher recurrence than radiofrequency ablation (RFA), and the optimal procedural endpoint remains undefined.

Objective

The purpose of this study was to identify the association of cryoablation procedural endpoints with postprocedural AVNRT recurrence.

Methods

We performed a single-center, retrospective analysis of pediatric patients following successful first-time cryoablation for AVNRT between January 1, 2011, and December 31, 2019. Preablation inducibility of AVNRT was recorded. Procedural endpoints, including slow pathway (SP) conduction (presence of jump or echo beats) with and without isoproterenol, were identified. Recurrence was established from clinical notes and/or direct patient contact.

Results

Of 256 patients, 147 (57%) were assessed on isoproterenol precryoablation, and 171 (47%) were assessed on isoproterenol postcryoablation. Mean cryolesion time was 2586 ± 1434 seconds. Following ablation, 104 (41%) had some evidence of residual SP conduction. With median follow-up time of 1.9 [0.7–3.7] years, recurrence occurred in 14 patients (5%). Complete elimination of SP conduction (with and without isoproterenol) had a hazard ratio for recurrence of 1.26 (95% confidence interval [CI] 0.42–3.8; P = .68) on univariate analysis and 1.39 (95% CI 0.36–5.4; P = .63) on multivariate analysis (including demographics, ablation time, 8-mm cryocatheter, and baseline inducibility).

Conclusion

The observed AVNRT recurrence rate after cryoablation was comparable to that of RFA. The presence of residual SP conduction was not associated with recurrence. This suggests that jump or single echo beat may be an acceptable endpoint in AVNRT cryoablation.

中文翻译：

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确定房室结折返性心动过速儿童冷冻消融的适当终点：残余慢通路传导与复发相关吗？

背景

由于其安全性，冷冻消融越来越多地用于治疗房室结折返性心动过速 (AVNRT)。然而，冷冻消融术可能比射频消融术 (RFA) 具有更高的复发率，并且最佳手术终点仍未确定。

客观的

本研究的目的是确定冷冻消融程序终点与术后 AVNRT 复发的关联。

方法

我们在 2011 年 1 月 1 日至 2019 年 12 月 31 日期间对 AVNRT 首次成功冷冻消融后的儿科患者进行了单中心回顾性分析。记录了 AVNRT 的消融前诱导性。确定了程序终点，包括有和没有异丙肾上腺素的慢通路 (SP) 传导（存在跳跃或回声）。复发是根据临床记录和/或直接患者接触确定的。

结果

在 256 名患者中，147 名 (57%) 接受了异丙肾上腺素预冷冻消融评估，171 名 (47%) 接受了异丙肾上腺素冷冻消融后评估。平均冷冻时间为 2586 ± 1434 秒。消融后，104 人 (41%) 有一些残余 SP 传导的证据。中位随访时间为 1.9 [0.7–3.7] 年，14 名患者 (5%) 发生复发。完全消除 SP 传导（有或无异丙肾上腺素）的单变量分析复发风险比为 1.26（95% 置信区间 [CI] 0.42–3.8；P = .68）和 1.39（95% CI 0.36–5.4；P = .63) 进行多变量分析（包括人口统计、消融时间、8 毫米冷冻导管和基线诱导性）。

结论

冷冻消融后观察到的 AVNRT 复发率与 RFA 相当。残余 SP 传导的存在与复发无关。这表明跳跃或单回波跳动可能是 AVNRT 冷冻消融中可接受的终点。