Ablação por radiofrequência da taquicardia por reentrada nodal: experiência com 112 pacientes no Instituto Nacional de Cardiologia (2012-2015)
Ablação por radiofrequência da taquicardia por reentrada nodal: experiência com 112 pacientes no Instituto Nacional de Cardiologia (2012-2015)
Data
2017
Autores
Rodrigues, Leandro Cordeiro Dias
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
As taquicardias paroxísticas supraventriculares são arritmias comuns na prática clínica, que apesar de geralmente evoluírem benignamente, podem incidir com sintomas desconfortáveis e trazer custos significativos em tratamentos, diagnósticos e hospitalizações. A taquicardia por reentrada nodal é a forma mais comum de taquicardia paroxística supraventricular, perfazendo 50% dos casos. O tratamento definitivo de escolha desta é a ablação por cateter, pois é um procedimento seguro com taxas de sucesso próximas a 98% e com taxas de complicações graves menores do que 1,0%, sendo a mais comum o bloqueio atrioventricular total. O presente trabalho objetivou o estudo das taxas de sucesso, insucesso e de complicações da ablação da taquicardia por reentrada nodal no Instituto Nacional de Cardiologia, sendo estas variáveis analisadas retrospectivamente em todos os pacientes submetidos a estudo eletrofisiológico e/ou ablação durante o período de janeiro de 2012 a dezembro de 2015, em que durante o procedimento foi diagnosticado taquicardia por reentrada nodal ou presença de dupla via nodal em pacientes sintomáticos com ou sem documentação eletrocardiográfica prévia de surto de taquicardia paroxística supraventricular. Estes critérios contemplaram 112 pacientes que foram submetidos a 116 ablações de taquicardia por reentrada nodal. As taxas de sucesso imediato, complicações graves e de recidivas foram 99,1%, 2,7% e 13,2% respectivamente. Em relação as complicações graves, dois (1,8%) pacientes evoluíram com bloqueio atrioventricular total durante aplicação de radiofrequência necessitando de implante de marcapasso definitivo e um paciente evolui com hematoma retroperitoneal necessitando de hemotransfusão e suporte intensivo. Finalmente, é importante ressaltar que taxa de sucesso imediato foi de 99,1 %. A ablação por radiofrequência da taquicardia por reentrada nodal mostrou-se um procedimento seguro. Complicações graves ocorreram em três (2,7%) pacientes e foram tratadas sem resultar em nenhum caso de óbito.
Supraventricular paroxysmal tachycardia are common arrhythmias in clinical practice, which, that despite being benignly, may present with uncomfortable symptoms and cause significant costs in treatment, diagnosis and hospitalization. Atrioventricular nodal reentrant tachycardia is the most common form of paroxysmal supraventricular tachycardia, accounting for 50% of cases. The definitive treatment of choice for this is catheter ablation, since it is a safe procedure with success rates close to 98% and with severe complication rates lower than 1.0%, the most common being complete atrioventricular block. The present study aimed to study the success, failure, and complication rates of atrioventricular nodal reentrant tachycardia at the Instituto Nacional de Cardiologia. These variables were retrospectively analyzed in all patients submitted to electrophysiological and/or ablation studies during the period of January from 2012 to December 2015, which during the procedure, atrioventricular nodal reentrant tachycardia or presence of dual atrioventricular nodal pathway was diagnosed in symptomatic patients with or without previous electrocardiographic documentation of a supraventricular tachycardia crisis. These criteria included 112 patients who underwent 116 atrioventricular nodal reentrant tachycardia ablations. Immediate success rates, severe complications and relapses were 99.1%, 2.7% and 13.2%, respectively. Regarding the severe complications, two (1.8%) patients evolved with complete atrioventricular block during radiofrequency application requiring definitive pacemaker implantation, and one patient evolved with retroperitoneal hematoma requiring blood transfusion and intensive care support. Finally, it is important to note that the success rate was 99.1 %. Radiofrequency ablation of the atrioventricular nodal reentrant tachycardia proved to be a safe procedure. Severe complications occurred in three (2.7%) patients and were treated without resulting in any death.
Supraventricular paroxysmal tachycardia are common arrhythmias in clinical practice, which, that despite being benignly, may present with uncomfortable symptoms and cause significant costs in treatment, diagnosis and hospitalization. Atrioventricular nodal reentrant tachycardia is the most common form of paroxysmal supraventricular tachycardia, accounting for 50% of cases. The definitive treatment of choice for this is catheter ablation, since it is a safe procedure with success rates close to 98% and with severe complication rates lower than 1.0%, the most common being complete atrioventricular block. The present study aimed to study the success, failure, and complication rates of atrioventricular nodal reentrant tachycardia at the Instituto Nacional de Cardiologia. These variables were retrospectively analyzed in all patients submitted to electrophysiological and/or ablation studies during the period of January from 2012 to December 2015, which during the procedure, atrioventricular nodal reentrant tachycardia or presence of dual atrioventricular nodal pathway was diagnosed in symptomatic patients with or without previous electrocardiographic documentation of a supraventricular tachycardia crisis. These criteria included 112 patients who underwent 116 atrioventricular nodal reentrant tachycardia ablations. Immediate success rates, severe complications and relapses were 99.1%, 2.7% and 13.2%, respectively. Regarding the severe complications, two (1.8%) patients evolved with complete atrioventricular block during radiofrequency application requiring definitive pacemaker implantation, and one patient evolved with retroperitoneal hematoma requiring blood transfusion and intensive care support. Finally, it is important to note that the success rate was 99.1 %. Radiofrequency ablation of the atrioventricular nodal reentrant tachycardia proved to be a safe procedure. Severe complications occurred in three (2.7%) patients and were treated without resulting in any death.
Description
Palavras-chave
Taquicardia supraventricular, Taquicardia por reentrada nodal, Ablação por cateter, Bloqueio atrioventricular, Atrioventricular nodal reentry tachycardia, Catheter ablation, Atrioventricular block, Supraventricular tachycardia
Citação
Rodrigues LCD. Ablação por radiofrequência da taquicardia por reentrada nodal: experiência com 112 pacientes no Instituto Nacional de Cardiologia (2012-2015). Rio de Janeiro. Dissertação [Mestrado Profissional em Ciências Cardiovasculares] - Instituto Nacional de Cardiologia; 2017.