心内接触与非接触性标测指导导管消融术治疗儿童频发室性早搏  

Radiofrequency catheter ablation for frequency premature ventricular contractions guided by contact mapping or non-contact mapping in pediatric patients

作　　者：曾少颖[1] 石继军[1] 李渝芬[1] 张智伟[1] 叶钜亨[1] 

机构地区：[1]广东省人民医院心儿科,广东广州510080

出　　处：《中国实用儿科杂志》2008年第10期733-735,801,802,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的比较心内接触与非接触性标测在指导儿童频发室性早搏导管消融术中的优越性、安全性和适应证的选择。方法研究对象为2002年8月至2008年6月广东省人民医院收治的8例无器质性心脏病的频发室性早搏患儿,24h室早总数平均(30000±8465)个。采用Ensite非心内接触性标测系统指导消融4例,年龄10～14岁,右室流出道2例,右室流入道2例;传统心内接触性标测指导消融4例,年龄6～10岁,右室流出道2例,右室流入道1例,左室流出道1例。术前和术后1、3个月记录24h室早总数,记录两种方法的X线曝光时间、并发症和适应证。结果两种方法术后均获即刻成功,无并发症发生,7例术后1、3个月室早总数0～5个/24h,其中1例左室流出道室早复发,先后2次消融成功;X线曝光时间右室流出道:16.5min vs 32.5min,右室流入道:26.5min vs 60min,心内接触性标测消融左室流出道室早:90min。结论EnSite非接触性三维标测较接触性标测下消融有许多优越性,但同样也存在着局限性,心内接触性标测适应性广,是非接触性三维标测的基础和补充,尤其在EnSite非接触性三维标测标测失败时。Objective To investigate the effect and indication of radiofrequency catheter ablation （ RFCA） by contact mapping or non- contact mapping on frequency premature ventricular contractions （ PVCs ） in pediatric patients. Methods Eight pediatric patients with PVCs in pediatric department without structural heart diseases were induced in the study. All of patient＇s Holter. PVCs 30000 ± 8465/24h. Guided by non- contact mapping, radiofrequency catheter ablation was performed on 4 patients [ mean age （ 11.3 ± 1.2 ） years ] ,2 patients with PVCs originating from the right ventricular outflow tract, and 2 patients with PVCs originating from the right ventricular inflow tract. Guided by contact mapping, radiofrequency catheter ablation was performed on 4 patients[ mean age （8 - 2） years] ,2 patients with PVCs originating from the right ventricular outflow tract（ RVOT）, 1 patient from the right ventricular inflow tract l RVIT）, and 1 patient from the left ventricular outflow tract （LVOT）. We calculated the fluoroscopic time, the complications, and the indication to select. All patients received 24-hour Holter ECG monitoring before RFCA at one and three months after RFCA. Results PVCs were successfully ablated in 8 cases. No ablation-related complications happened. One patient with PVCs originating from LVOT recurred one month after RFCA, and needed a second successful ablation. After a follow-up of 3 months, Hoher records of the successfully ablated patients indicated PVC 0 - 5 个/24h. In non- contact mapping group,the fluoroscopic time of ablation PVCs originating from RVOT was 16. 5 min vs 32. 5 min, from RVIT,26. 5 min vs 60 min. In contact mapping group,the fluoroscopic time of ablation PVCs originating from LVOT was 90 min. Conclusion Non- contact mapping has many advantages compared to contact mapping, such as, shortening the fluoroscopic time, but it also has some limitations. Contact mapping has wide adaptability ; it can be the foundation and supplement of non- contact mapping, especi

关 键 词：儿童 室性早搏 接触标测非接触标测 导管消融 

分 类 号：R72[医药卫生—儿科]