儿童肺动脉窦起源的室性心律失常射频消融治疗及随访  

Radiofrequency ablation of ventricular arrhythmias from the pulmonary sinus cusp in pediatric patients and the follow-up

作　　者：刘甜[1] 梁东坡[1] 洪钿 王树水[1] 张智伟[1] 石继军[1] 钱明阳[1] 李渝芬[1] 曾少颖[1] Liu Tian;Liang Dongpo;Hong Dian;Wang Shushui;Zhang Zhiwei;Shi Jijun;Qian Mingyang;Li Yufen;Zeng Shaoying(Department of Pediatric Cardiology,Guangdong Cardiovascular Institute,Guangdong Provincial Key Laboratory of South China Structural Heart Disease,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510800,China)

机构地区：[1]广东省心血管病研究所,广东省华南结构性心脏病重点实验室,广东省人民医院,广东省医学科学院心儿科,广州510800

出　　处：《中华实用儿科临床杂志》2022年第6期439-442,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家重点研究发展计划项目(2018YFC1002602)。

摘　　要：目的探讨儿童肺动脉窦(PSC)起源的室性心律失常(VAs)射频消融方法及安全性。方法回顾性研究。选择2014年3月至2020年7月广东省人民医院心儿科成功行射频消融治疗的15例PSC起源的VAs患儿,患儿均符合射频消融手术适应证,总结其心电图特点及射频消融方法,射频消融术中根据患儿的年龄、体质量选择不同弯型的消融导管,将消融导管采用倒"U"型或倒"P"型的方法送至PSC,术后随访预后,评价其安全性。结果患儿年龄6~15(11.6±2.6)岁,体质量19~65(39.9±12.2)kg,PSC起源VAs的体表心电图呈左束支阻滞图形,下壁导联R波直立,aVR、aVL导联呈QS型,各个PSC起源VAs表现有差异。术中患儿均在右心室流出道未寻找到理想的激动点或消融不成功。在PSC内标测到最早的靶点及消融成功。15例VAs的起源点均位于肺动脉窦底部,起源于右窦者11例(73.3%),前窦者3例(20.0%),左窦者1例(6.7%),靶点处局部电位较体表QRS波提前(27.3±6.0)ms。随访(2.7±2.0)年,无VAs复发及并发症出现。结论在导管操作轻柔、消融功率适当的前提下,儿童起源于PSC内的VAs消融成功率高、复发率低、安全性高。Objective To evaluate the strategy and safety of the radiofrequency ablation(RFA)on ventricular arrhythmias(VAs)originating from the pulmonary sinus cusp(PSC)in pediatric patients.Methods Retrospective study.Fifteen patients with VAs originating from the PSC who were intervened by RFA in the Department of Pediatric Cardiology,Guangdong Provincial People′s Hospital between March 2014 to July 2020 were enrolled.All the patients met the indication criteria for RFA in pediatric patients.The electrocardiogram,ablation method of ablation were analyzed.Different curved catheters were selected for RFA according to the age and weight of the patients.The catheter was then inserted in a"U"or inverted"P"shape to the PSC.The long-term effect of ablation were reviewed.Results The mean age and body weight of 15 patients with VAs originating from the PSC were(11.6±2.6)(6-15)years and(39.9±12.2)(19-65)kg,respectively.The electrocardiogram recorded during VAs originating from the PSC showed left bundle branch block and inferior axis with monomorphic R pattern,as well as a QS-wave in aVR and aVL.The electrocardiogram characteristics varied in patients with VAs originating from the PSC.The ideal excitation point was not found in the right ventricular outflow tract or the ablation was unsuccessful in all patients,and the earliest target was mapped and RFA was successful.Among the 15 patients,the successful ablation site was in the lower regions of the PSC,involving the right cusp in 11 patients(73.3%),the anterior cusp in 3 patients(20.0%),and the left cusp in 1 patient(6.7%).The earliest potential recorded at the PSC ablation site preceded the QRS complex onset by(27.3±6.0)ms.During the follow-up period for(2.7±2.0)years,no recurrence of VAs or complications were recorded.Conclusions Under the premise of gentle catheterization procedure and appropriate radiofrequency energy,ablation was effective,safe and with low recurrence rate to eradicate VAs originating from the PSC in children.

关 键 词：室性心律失常 肺动脉窦 射频消融 儿童 

分 类 号：R725.4[医药卫生—儿科]