三维电生理标测系统在儿童心律失常导管消融中的应用  

Radiofrequency catheter ablation of arrhythmias in pediatric patients guided by three-dimensional mapping system

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

机构地区：[1]广东省人民医院广东省心血管病研究所儿科,广州510080

出　　处：《中华儿科杂志》2009年第9期705-709,共5页Chinese Journal of Pediatrics

基　　金：基金项目：2008年度广东省科技计划资助项目（20088030301167）;2008年度广东医学科研基金资助项目（A2008057）

摘　　要：目的探讨三维标测系统（carto和Ensite）在指导儿童心律失常导管消融中的安全性、适应证和优越性。方法①在Carto指导下房性心动过速（atrialtachycardia，AT）消融8例；年龄（6．2±1．7）岁，体重（18．0±2．0）kg。②在Ensite指导下心律失常消融10例。其中应用EnsiteArray系统指导消融8例，包括频发右室室性早搏（prematureventricularcontractions，PVCs）6例，右房AT2例，年龄（11．3±1．2）岁，体重（40．0±5．0）kg；应用EnsiteNavX系统指导消融2例，为B型预激综合征。结果①在Caao指导下8例AT患儿成功消融，其中“切口”性AT6例，左房耳AT和右房AT各1例；1例“切口”AT术后3个月复发，再次消融成功。②在EnsiteArray指导下6例频发右PVCs和2例右房AT患儿成功消融，其中PVCs从术前（323334-4509）个／24h下降至0—4个／24h；1例AT患儿1d后出现另一种周期的AT。在EnsiteNavx指导下成功消融2例B型预激综合征。随访6个月无复发。结论Caao系统适合持续心律失常患儿的检测，而EnsiteArray系统适合大于10岁、不持续右心心律失常患儿的检测；EnsiteNavX可迅速建模，显示心内解剖结构。Objective To explore safety, indications and advantages of mapping and ablation of arhythmia in children guided by Carto and Ensite system. Methods Guided by Carto system, radiofrequency catheter ablation （RFCA） was performed on 8 pediatric patients with tachycardia whose mean age was （ 6. 2 ± 1.7 ） years, mean weight was （ 18.0 ± 2. 0 ） kg. Guided by Ensite system, RFCA was performed on 10 pediatric patients with arhythmia, 8 of them were ablated guided by Ensite Array system： 6 cases with premature ventricular contractions（PVCs） , 2 cases with right atrial tachycardia, their mean age was （ 11.3 ± 1.2） years, and mean weight （40. 0 ± 5.0） kg. The other two cases with W-P-W syndrome were ablated guided by Ensite Navx system. Result Guided by Carto system, 8 cases were successfully mapped and ablated： 6 cases had incision atrial tachycardia, 1 case had left atrial tachycardia and 1 case had right atrial tachycardia. In 1 case with incision atrial tachycardia the condition recurred after 3 months, and was ablated again successfully. Guided by Ensite Array system, 6 cases with PVCs （ in 2 originating from the right ventricular inflow tract and in 4 originating from the right ventricular outflow tract） and 2 cases with right atrial tachycardia were successfully mapped and ablated, PVCs of the first 6 cases were reduced from （32 333 ±4509）24 h to （0-4）/24 h after ablation. In 1 case with automatic atrial tachycardia, mapping could not be done by Ensite Array system, because P wave could not be identified from T wave. Single bolus of adenosine 20 mg was given within 30 s to let ventricles stop for 2 s （ cardioventrieular pacing standby） until T wave vanished, mapping and ablation were operated again successfully, but another atrial tachycardia occurred 1 day later. Guided by Ensite Navx system, 2 cases with W-P-W syndrome were successfully ablated, operation under X-rays lasted for 8 and 10 min. In none of the 9 patients the disease recurred after follow-up for 6 months.

关 键 词：电生理学 儿童 心律失常 导管消融术 CARTO系统 Ensite系统 

分 类 号：R686[医药卫生—骨科学]