儿童流出道室性心律失常射频消融疗效探讨  

Efficacy of radiofrequency catheter ablation of outflow tract ventricular arrhythmias in children

作　　者：江河[1] 李小梅[1] 李延辉[1] 刘海菊[1] 张仪[1] 戈海延[1] 

机构地区：[1]清华大学医学中心清华大学第一附属医院(华信医院)心脏中心小儿科,北京100016

出　　处：《中华儿科杂志》2016年第4期254-258,共5页Chinese Journal of Pediatrics

基　　金：伍舜德博士医学科学研究基金（202-400-00811）;首都医学发展科研基金（2014-1-4121）

摘　　要：目的探讨儿童流出道室性心律失常特点以及射频消融疗效及策略。方法回顾性分析2012年1月至2015年7月因流出道室性心律失常在清华大学第一附属医院住院的53例患儿射频消融手术资料，其中男34例、女19例，年龄（8±3）岁，体重（33±13）kg。患儿均符合射频消融手术适应证而接受手术治疗，结合手术资料分析该类室性心律失常发病年龄、表现形式、好发部位以及消融疗效及策略。结果53例流出道室性心律失常患儿平均发病年龄（8±4）岁。频发室性期前收缩为主要表现形式，占68％（36例）。流出道室性心律失常主要起源于右室流出道，占66％（35例），以肺动脉瓣下1cm区域（89％，31／35）及间隔（77％，27／35）多见。射频消融即时成功率为98％（52／53），远期复发率10％（5／52），手术并发症发牛率2％（1／53）。x线曝光量（743±323）mGay·cm^2。6例患儿术中需要实施双侧标测消融。结论儿章流出道室性心律失常以右室流出道起源最多见，射频消融治疗安全有效，部分病例术中需要实施双侧标测消融。Objective To explore the features of outflow tract ventricular alThythmias （OTVA） in children and evaluate the efficacy and experiences of radiofrequency catheter ablation （RFCA） . Method Data were collected and analyzed on 53 consecutive pediatric patients who underwent RFCA for OTVA from January 2012 to July 2015 in the First Hospital of Tsinghua University. These children included 34 male and 19 female, whose average age was （8±3） years and body weight was （33±13） kg. All the children met the indication criteria for RFCA of OTVA in children. Data were analyzed about the onset age, the forms and ablation efficacy and strategies of OTVA. Result The average age of onset was （8±4 ） years. Of these children, 68% （36/53） had frequent premature ventricular complex which was the main arrhythmia pattern. The proportion of 66% （35/53） were of right ventricular outflow tract （RVOT）. The vast majority of RVOT ventricular arrhythmias originates frmn myocardium with in the first 1 cm beneath the pulmonary valve （89% ,31/35） or the septal region（77%, 27/35 ）. The total acute success rate was 98% （52/53）, the recurrence rate on follow-up was 10% （5/52） and the complications of the procedure was 2% （1/53）. The X-ray exposure dose was（743±323 ） mGay·cm^2. However, for 6 of the children RFCA on both sides of outflow tract was necessary for success. Conclusion OTVA in children originates mostly from RVOT. RFCA can be used for ablation of pediatric OTVA effectively and safely. In some cases, successful RFCA should be performed on both sides of outflow tract.

关 键 词：导管消融术 心律失常 心性 儿童 

分 类 号：R725.4[医药卫生—儿科]