单中心近5年小儿特发性室性心律失常328例射频消融分析  

Analysis of radiofrequency catheter ablation of idiopathic ventricular arrhythmias in 328 pediatric patients in a single center within 5 years

作　　者：江河 李小梅 张仪 李梅婷 刘海菊 李璟昊 周挥茗 Jiang He;Li Xiaomei;Zhang Yi;Li Meiting;Liu Haiju;Li Jinghao;Zhou Huiming(Division of Pediatric Cardiology,the First Hospital of Tsinghua University,Beijing 100016,China)

机构地区：[1]清华大学第一附属医院心脏中心小儿科,北京100016

出　　处：《中华实用儿科临床杂志》2021年第19期1458-1462,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：首都临床特色应用研究(Z181100001718207);吴阶平医学基金会临床科研专项资助基金(320.6750.18502)。

摘　　要：目的探讨小儿特发性室性心律失常(VAs)的电生理特点和射频消融效果。方法2014年1月至2019年12月清华大学第一附属医院接受射频消融的特发性VAs患儿328例,其中男205例,女123例;年龄(7.8±3.9)岁;体质量(32.8±17.7)kg。分析儿童不同起源位置VAs电生理特点和射频消融结果。结果328例患儿首次发病年龄为(5.4±4.1)岁,频发室性期前收缩占57.6%,非持续室性心动过速占28.7%,持续室性心动过速占13.7%;合并心动过速性心肌病38例(11.6%,38/328例)。328例患儿中除13例术中未能诱发VAs,315例经标测证实VAs起源于流出道152例(152/328例,46.4%),其中右心室流出道间隔部位46.1%、左冠窦27.6%、右冠窦18.4%、右心室流出道游离壁7.9%;三尖瓣环55例(55/328例,16.5%);左后分支54例(54/328例,17.4%);左心室后乳头肌39例(39/328例,11.9%);多源性5例(5/328例,1.5%);左前分支3例(3/328例,0.9%);其他7例(7/328例,2.1%)。接受射频消融307例(307/328例,93.6%),即时成功271例(271/307例,88.3%),有效14例(14/307例,4.6%),失败22例(22/307例,7.2%)。随访3~36个月,再发42例(42/271例,15.5%)。手术曝光时间(3.2±5.8)min,曝光量(1.4±2.6)mGy,剂量面积乘积(384.2±42.6)mGy·cm2。术中发生相关血管并发症4例(4/328例,1.2%)。本组资料中≤3岁婴幼儿20例,除1例术中未诱发外,余19例均行射频消融,即时成功18例(18/19例,94.7%),随访复发4例(4/18例,22.2%),术中发生相关血管并发症1例(1/20例,5.0%),无心肌穿孔、心包填塞及房室阻滞等严重并发症。结论起源于流出道的儿童特发性VAs以右心室流出道间隔部位最常见;流出道及三尖瓣环起源消融效果较好,左心室分支型及左后乳头肌起源复发率相对较高;婴幼儿特发性VAs射频消融相对安全有效,但应严格掌握手术适应证,并由经验丰富的儿科电生理医师操作;三维标测指导射频消融可将辐射量控制在极低的安全范围。Objective To investigate clinical electrophysiological characteristics of idiopathic ventricular arrhythmias(VAs)and outcomes of radiofrequency catheter ablation(RFCA)in pediatric patients.Methods A total of 328 consecutive pediatric patients with VAs and treated with RFCA in the First Hospital of Tsinghua University from January 2014 to December 2019 were recruited,involving 205 males and 123 females with the mean age of(7.8±3.9)years and the mean body weight of(32.8±17.7)kg.Their clinical electrophysiological characteristics,RFCA outcomes of different origins of VAs and complications were analyzed.Results Among the 328 patients with the mean onset age of(5.4±4.1)years,57.6%had frequent premature ventricular complex(PVC),28.7%had paroxysmal ventricular tachycardia(VT)and 13.7%had incessant VT.A total of 38/328 cases(11.6%)VAs children were complicated with tachycardia-induced cardiomyopathy.Except for 13 cases of non-induced VAs,among 315 cases there were 152/328 cases(46.4%)originated from the ventricular outflow tract(including 46.1%of the origination of the right ventricular outflow tract septum,27.6%of the origination of the left coronary cusp,18.4%of the origination of the right coronary cusp,and 7.9%of the origination of the right ventricular outflow tract free wall),55/328 cases(16.5%)originated from the tricuspid valve,54/328 cases(17.4%)originated from the left posterior fascicle,39/328 cases(11.9%)originated from the left posterior papillary muscle,5/328 cases(1.5%)originated from multi-origin VAs,3/328 cases(0.9%)originated from the left anterior fascicle,and 7/328 cases(2.1%)originated from other origins.Among 307/328 cases(93.6%)VAs patients receiving RFCA,271/307 cases(88.3%)were instantly successful,14/307 cases(4.6%)were effectively treated and 22/307 cases(7.2%)were invalid.During the follow-up time of 3 to 36 months,there were 42/271 cases(15.5%)recurrent cases.The mean radiation time and dose were(3.2±5.8)min,and(1.4±2.6)mGy,respectively.The mean dose-area product(DAP)was(384.2±42.6)mGy�

关 键 词：室性心律失常 射频消融 心动过速性心肌病 儿童 

分 类 号：R725.4[医药卫生—儿科]