儿童室间隔修补术后远期心房内折返性心动过速的消融  

Radiofrequency catheter ablation of atrial tachycardia after repairing of the ventricular septal defect inpediatrics

作　　者：高路[1] 袁越[1] 林利[1] 崔娘[1] 姚焰[2] 

机构地区：[1]首都医科大学附属北京儿童医院心脏中心内科,北京100045 [2]中国医学科学院心血管病研究所北京协和医学院阜外心血管病医院心律失常中心

出　　处：《中华心律失常学杂志》2011年第6期414-417,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的报道儿童先天性心脏病室间隔缺损（VSD）术后远期出现的心房内折返性心动过速（IART）的电生理标测及导管消融疗效。方法8例患儿（男、女各4例），平均年龄（7．1±4．1）岁，VSD术后1～5年发生持续性IART，8例均有左心室扩大，其中5例合并慢性心力衰竭。行心房电生理标测，部分应用三维标测（EnSiteNavX）技术，标测折返环的关键峡部并行导管消融。结果8例均自发IART，折返环关键部位分布：6例位于三尖瓣环峡部，1例于右心房界嵴至下腔静脉间，1例于三尖瓣环9点位置至界嵴问。所有（100％）患儿手术即刻成功，无并发症。平均随访（25．2±16．5）个月，2例复发，其中1例再次消融成功，总成功率7／8（87．5％）。左心室人小及射血分数均明显好转。结论儿童VSD术后IART机制多为三尖瓣环一下腔静脉峡部依赖型心房扑动，可经导管消融治愈或明显改善。三维标测技术能准确快速定位折返环的电生理峡部并指导消融，显著减少曝光时间。Objective This study aimed to investigate the effects of electrophysiological study（EPS） and radiofrequeney（RF） catheter ablation of intra-atrial reentrant tachycardia（IART） after repairing the congen- ital ventrieular septal defect （VSD）in pediatrics. Methods Eight children（4 boys, and 4 girls, mean age 7. 1 ＋ 4. 1 years） ,who experienced incessant IART 1-5 years after VSD surgery,underwent EPS and RF ablation. All children had dilated left ventricle （ LV）, and 5 of 8 demonstrated severely LV dilation and congestive heart fail- ure before ablation. RF energy was delivered to the critical isthmus of the reentry circuit of IART. Results All children have spontaneous AT at the beginning of the procedure. All of the IARTs was macro-reentrant mecha- nism. The critical isthmus was located at the isthmus between inferior vena eava（IVC）-tricuspid valve annulus （TVA） in 6 ,between the erista teminalis（CT） and IVC in 1, and between CT and 9 o＇ clock of TVA in 1. RF ablation was acutely successful in 8 （ 100% ） patients without any complications. During a follow-up period of （25.2-＋ 16. 5 ）months ,2 children had recurrence of AT, and 1 had the successfully second procedure. The total success rate was 7/8 （87. 5% ）. The children with dilated LV before ablation had improved LV diameter and function. Conclusion The mechanism of IART after repair of VSD is mainly the atrial flutter using the isthmus between IVC-TVA, and can be cured by RF ablation. The 3-dimensional mapping technique helps to accurately and quickly define the isthmus of reentrant circuit and guide ablation.

关 键 词：儿童 先天性心脏病 房性心动过速 射频导管消融 复发 

分 类 号：R726.5[医药卫生—儿科]