房间隔穿刺术在儿童左侧旁路所致阵发性室上性心动过速导管消融中的应用  

Application of transseptal puncture to radiofrequency catheter ablation in children with left accessory pathway induced paroxysmal supraventricular tachycardia

作　　者：朱玲[1] 林约瑟[1] 李轩狄[1] 李淑娟[1] 王慧深[1] 冯冲[2] 唐安丽[2] Zhu Ling;Lin Yuese;Li Xuandi;Li Shujuan;Wang Huishen;Feng Chong;Tang Anli(Department of Pediatric Cardiology,the First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China;Department of Cardiology,the First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院心血管儿科,广州51OO8O [2]中山大学附属第一医院心血管内科,广州510080

出　　处：《中华实用儿科临床杂志》2019年第4期278-281,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨房间隔穿刺术在儿童左侧旁路所致阵发性室上性心动过速(PSVT)导管消融中的应用价值。方法回顾性分析2012年1月至2017年12月在中山大学附属第一医院行导管消融术的33例左侧旁路所致PSVT患儿的临床资料,将其分为主动脉逆行消融组和房间隔入路消融组,分析即刻手术成功率,比较手术总透视时间和射线量,观察术中、术后并发症及复发率。结果共33例患儿,男22例,女11例。主动脉逆行消融组19例,房间隔入路消融组18例(其中包括4例主动脉逆行消融复发患儿),年龄分别为(10.16±3.06)岁和(10.67±2.20)岁,体质量分别为(37.68±14.28)kg和(37.33±8.64)kg,2组比较差异均无统计学意义(均P>0.05);手术总透视时间分别为(20.16±11.41)min和(12.56±5.23)min,射线量中位数分别为67.0mGy和33.5mGy,术后复发率2组分别为21%(4/19例)和0(0/18例),2组比较差异均有统计学意义(t=2.627、Z=-2.31、χ^2=4.249,均P<0.05)。2组均未发现明确并发症。结论房间隔穿刺术在儿童左侧旁路所致PSVT导管消融中安全可行,房间隔入路消融可降低术后复发率,左侧旁路消融应首选房间隔入路进行。Objective To explore the value of transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with paroxysmal supraventricular tachycardia(PSVT).Methods Thirty-three patients with PSVT who had underwent radiofrequency catheter ablation in the First Affiliated Hospital,Sun Yat-Sen University from January 2012 to December 2017 were retrospectively analyzed.All the cases were treated by transaortic approach(transaortic group)or transseptal approach(transseptal group).The immediate success rates,total fluoroscopy time and radiation exposure between 2 groups were compared,and the perioperative complications and recurrence rates were observed between 2 groups.Results Thirty-three cases of children were enrolled,22 cases were male and 11 cases were female.Nineteen cases were treated by transaortic approach(transaortic group),while 18 cases were treated by transseptal approach(transseptal group),including 4 recurrent cases in the transaortic group who were switched to transseptal approach because of previous treatment failure.The age was(10.16±3.06)years and(10.67±2.20)years,and the weight was(37.68±14.28)kg and(37.33±8.64)kg,respectively.There were no significant diffe-rences in age and weight statistics between 2 groups(all P>0.05).The total fluoroscopy time was(20.16±11.41)minutes and(12.56±5.23)minutes,and the median dose of radiation exposure was 67.0 mGy and 33.5 mGy,respectively.The postoperative recurrence rate was 21%(4/19 cases)and 0(0/18 cases),respectively.There were significant differences in total fluoroscopy time,radiation exposure and recurrence rate statistics between 2 groups(t=2.627,Z=-2.31,χ^2=4.249,all P<0.05).No complications were found in both 2 groups.Conclusions It is safe and feasible by transseptal puncture for left-sided accessory pathway in radiofrequency catheter ablation in children with PSVT.Radiofrequency catheter ablation by transseptal approach could significantly reduce the postoperative recu-rrence rate,and should be the first choice fo

关 键 词：儿童 阵发性室上性心动过速 房间隔穿刺 左侧旁路 导管消融 

分 类 号：R725.4[医药卫生—儿科]