三维电解剖标测系统指引下导管射频消融治疗儿童室性早搏临床分析  

Clinical analysis of radiofrequency catheter ablation guided by Carto 3 in the treatment of ventricular premature beats in children

作　　者：徐萌[1] 李筠[1] 肖婷婷[1] 谢利剑[1] 王健怡[1] 姜逊渭 严蓁[1] XU Meng;LI Yun;XIAO Tingting;XIE Lijian;WANG Jianyi;JIANG Xunwei;YAN Zhen(Department of Cardiology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院心内科,上海200062

出　　处：《临床儿科杂志》2021年第4期247-250,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨三维电解剖标测系统(Carto 3)指引下儿童室性早搏(室早)经导管射频消融术治疗的临床疗效及右室流出道室早消融前后自主神经功能的改变。方法回顾分析2015年1月—2019年12月收治的42例频发室早患儿经射频消融术治疗的临床资料,比较右室流出道室早患儿术前和术后3个月的心率变异性(HRV)及心率减速力(DC)。结果室早起源于右心室流出道23例、三尖瓣环5例、右室游离壁4例、左室流出道4例、二尖瓣环及左后分支各2例。其中2例术后延迟愈合,1例复发,2例失败,手术成功率92.9%(39/42),无手术并发症。23例右室流出道室早患儿射频消融术前和术后3个月24小时动态心电图HRV指标显示,时域指标即全部正常窦性R-R间期标准差(SDNN)术后高于术前,差异有统计学意义(P<0.05)。频域指标即高频功率(HF)术后高于术前,高低频功率比值(LF/HF)术后低于术前,差异有统计学意义(P<0.05)。术后DC值高于术前,差异有统计学意义(P<0.05)。结论Carto3指引下儿童室早射频消融术治疗安全、有效;右室流出道室早患儿表现为自主神经功能受损,以迷走神经张力减弱为主。Objective To explore the clinical effect of radiofrequency catheter ablation(RFCA)guided by Carto 3 for ventricular premature beats(VPBs)and the changes of autonomic nerve function before and after RFCA of the right ventricular outflow tract in children.Methods The clinical data of 42 children with frequent VPBs admitted from January 2015 to December 2019 were retrospectively analyzed.The heart rate variability(HRV)and deceleration capacity of rate(DC)of children with VPBs originated from the right ventricular outflow tract(RVOT)before and 3 months after operation were compared.Results There were 23 cases of VPBs originated from the RVOT,5 cases from tricuspid annulus,4 cases from right ventricular free wall,4 cases from left ventricular outflow tract,2 cases from mitral annulus and 2 cases from left posterior branch.Among them,2 cases had delayed postoperative healing,1 case recurred.The other 2 cases failed.The surgical success rate was 92.9%(39/42),and there were no surgical complications.The 24-hour dynamic ECG HRV index before and 3 months after RFCA of the right outflow tract in 23 children with VPBs showed that the time domain index,namely the standard deviation of normal R-R intervals(SDNN),was higher than that before RFCA,and the difference was statistically significant(P<0.05).The frequency index,namely high frequency power(HF),was higher after RFCA than before,and the ratio of high and low frequency power(LF/HF)was lower after RFCA than before,and the differences were statistically significant(P<0.05).The DC value after RFCA was higher than that before RFCA,and the difference was statistically significant(P<0.05).Conclusions The RFCA guided by Carto 3 is safe and effective in the treatment of VPBs in children.The children with VPBs originated from right ventricular outflow tract show impaired autonomic nerve function,mainly weakened vagus nerve tone.

关 键 词：经导管射频消融术 室性早搏 右室流出道 自主神经 儿童 

分 类 号：R725.4[医药卫生—儿科]