儿童心动过速的心内电生理诊治分析:附40例报告  

Study on the diagnosis and treatment of childhood tachycardia with intracardiac electrophy-siology attached with reports of 40 cases

作　　者：李筠[1] 周爱卿[1] 朱敏[1] 杨健萍[1] 李奋[1] 黄美蓉[1] 高伟[1] 

机构地区：[1]上海交通大学医学院附属新华医院上海儿童医学中心心内科,上海200127

出　　处：《临床儿科杂志》2006年第3期212-214,共3页Journal of Clinical Pediatrics

摘　　要：目的 提高对儿童快速性心律失常的诊治技术。方法 于2003年11月～2005年1月对40例症状性心动过速患儿心内电生理检查（EPS）结果（结合体表心电图、食道心房调搏检查）及射频消融治疗（RFCA）的疗效、并发症及复发率进行分析。结果 EPS结果：22例（55．0％）为房室折返性心动过速（AVRT），其中左右侧旁道各11例；13例（32．5％）为房室结折返性心动过速（ANNRT）；3例（7．5％）为室性心动过速，其中2例为左室问隔部室速，1例为左室流出道室速；1例（2．5％）为不良性窦速；此外1例未能诱发心动过速。EPS与体表心电图：22例AVRT中8例为显性预激，根据胡氏的体表心电图对显性旁道定位流程图定位，其结果与EPS的符合率为88％。17例食道心房调搏检查（TEAP）诊断为AVNRT者中13例得到证实，符合率76．5％。RFCA结果：3例放弃RFCA，36例心动过速患儿行RFCA，成功率为100％，其中〈5岁2例，最小年龄为16个月。RFCA并发症发生率为3例，占7．5％，1例气胸，1例出现一过性Ⅱ度AVB，1例一过性的LBBB，均在48h内恢复正常。RFCA后4例复发，复发牢为10．0％，县中AVNRT3例（占75．0％），1例为右室游离壁旁道。结论 心内电生理诊治技术是一种安全、成功率高、并发症少的根治方法，但是对于年龄相对较小、合并有基础疾病、EPS显示手术风险较大的患儿须综合考虑，慎重掌握指征。Objective To improve the technique of intracardiac electrophysiologic study （EPS） and radio-frequency catheter ablation （RFCA） in children. Methods 40 patients with tachycardia were enrolled in the study. The data of EPS （combined with ECG and TEAP） and the results of RFCA （ablation success, complications and recurrence） were studied retrospectively. Results （1） The results of EPS： Among 40 patients, 22 cases （55.0%） with atrial ventricular reentrant tachycardia （AVRT） ; 13 cases （32.5%） with atrial ventricular node reentrant tachycardia （AVNRT）;3 cases （7.5%） with ventricular tachycardia （VT）;1 case （2.5%） with inappropriate sinus tachycardia ;however 1 case with tachycardia was not induced by EPS. In comparison of the results in EPS with ECG, 8 of the 22 cases with AVRT showed typical Wolff-Parkinson- White syndrome in EPS, with the coincidence of 88%. The results of EPS vs transesophageal atrial pacing （TEAP） ：Diagnosis of AVNRT with TEAP were confirmed by EPS in 17 cases with the accuracy of 76.5%. （2） The results of RFCA：RFCA was performed in 36 cases and all were successful. The procedure was abandoned in 3 patients because of considering the risk （one with appropriate sinus tachycardia, one with AVRT and AP location near His bundle, one with VT originated from left ventricular outlet and Mafan syndrome） . Complication rate was 7.5%, with pneumothorax, transient Ⅱ A-V block and left bundle branch block. But all of the complication subsided within 48 hours. Tachycardia recurred in 4 cases （3 AVNRT, 1 AVRT originated from right free wall） during follow up. Conclusions RFCA is a safe procedure with high success rate and low complication for tachycardia management, but the indications for RFCA should be carefully considered in the patients with small age, or underlying heart disease or greater risks of major complications happened.

关 键 词：儿童 心动过速 心内电生理检查 射频消融 

分 类 号：R725.4[医药卫生—儿科]