[Cryoenergy for the ablation of arrhythmogenic paraseptal substrates in children and adolescents with heart rhythm disorders].
OBJECTIVE
Cryoablation is safe for the ablation of substrates in proximity to the AV node, because the initial lesion is reversible. We report our results of cryoablation in a transregional center for ablation in children and adolescents.


METHODS
Data on 39 children and adolescents (4 - 18 years of age) who had been treated with cryo energy were analyzed retrospectively. The diagnosis was AV nodal reentry tachycardia (AVNRT; n = 30), para-Hisian accessory pathway (AP; n = 6) and congenital junctional ectopic tachycardia (JET; n = 4). In addition to non-inducibility, the targeted endpoint for AP-ablation was a missing or decremental concentric retrograde conduction, for ablation of AVNRT the endpoint was no slow pathway, no AH jumps and no echo-beats. The median follow-up was 3 years (270 - 1919 days).


RESULTS
The targeted endpoint was reached in 35/39 patients (90 %), in four patients (10 %) RF energy had to be applied. A recurrence occurred in 7/35 (20 %) successfully treated patients. Two patients had a pre-excitation again after AP ablation, but no symptoms. Thus, 28/35 patients (80 %) remained asymptomatic after cryoablation, and 26/35 (74 %) are definitively cured, regarding all follow-up data. The subgroup of AVNRT patients does not differ from the entire group. There was no AV block in the cryoablation group.


CONCLUSIONS
Cryoablation is very safe and effective for the definitive treatment of arrhythmias in children and adolescents. The price for the high safety is a reduced efficacy and a higher recurrence rate.
Kinderkardiologie, Herzzentrum, Uniklinik Köln. mathias.emmel@uk-koeln.de
M
M
Emmel
N
N
Sreeram
M
M
Khalil
K
K
Brockmeier
D058606:Accessory Atrioventricular Bundle / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003452:Cryosurgery; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000601:surgery*; D013613:Tachycardia, Ectopic Junctional / Q000151:congenital / Q000601:surgery*; D016896:Treatment Outcome