儿童右心耳起源局灶性房性心动过速42例分析  

Clinical characteristics of 42 children with focal atrial tachycardia originated from the right atrial appendage

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作  者:张仪 李小梅 江河 靳永强 李梅婷 古亚莉 周挥茗 Zhang Yi;Li Xiaomei;Jiang He;Jin Yongqiang;Li Meiting;Gu Yali;Zhou Huiming(Department of Pediatric Cardiology,Heart Center,the First Hospital of Tsinghua University(Beijing Huaxin Hospital),Beijing 100016,China)

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

出  处:《中华儿科杂志》2023年第8期714-718,共5页Chinese Journal of Pediatrics

基  金:首都临床特色应用研究(Z221100007422082);清华-裕元医学研究基金(20240000591)。

摘  要:目的探讨儿童右心耳起源房性心动过速(简称房速)的发作形式、治疗方式及效果。方法回顾性病例分析。收集2010年1月至2022年9月于清华大学第一附属医院心脏小儿科因房速就诊,经心内电生理检查确诊为右心耳起源房速的42例患儿的临床资料,分析其临床特征、治疗方式及效果,同时将患儿分为心动过速性心肌病和心功能正常组,比较两组患儿射频消融年龄及房速时心率的差异,组间比较采用独立样本t检验。结果42例患儿中男20例、女22例,发病年龄2.7(0.6,5.1)岁,射频消融年龄(6.5±3.6)岁,体重(23.4±10.0)kg,持续无休止性32例(76%),心动过速性心肌病的发生率为43%(18/42)。心动过速性心肌病组射频消融年龄大于心功能正常组,房速时心率高于心功能正常组,差异均有统计学意义[(8.1±3.8)比(5.3±3.1)岁,t=-2.63,P=0.012;(173±41)比(150±30)次/min,t=-2.05,P=0.047]。38例(90%)患儿曾接受过2种及以上抗心律失常药物治疗但房速均未治愈。射频消融即时成功率为57%(24/42),复发率为17%(4/24)。右心耳切除22例,切除术后房速均转复窦性心律。右心耳切除术中所见右心耳瘤者10例,右心耳瘤在射频消融失败的病例中,占9/18。结论儿童右心耳起源房速多表现为持续无休止性发作,抗心律失常药物治疗效果差,射频消融的成功率偏低、复发率较高,外科心耳切除为安全有效的补充根治方法。ObjectiveTo investigate the feature and treatment of atrial tachycardia(AT)originated from right atrial appendage(RAA)in children.MethodsThe data of 42 children with AT originated from RAA,who were admitted the First Hospital of Tsinghua University from January 2010 to September 2022 were analyzed retrospectively.The clinical characteristics,treatment and efficacy were analyzed.The children were divided into tachycardia cardiomyopathy group and normal cardiac function group.The differences in the ablation age and the heart rate during AT between two groups were compared by independent sample t-test.ResultsAmong 42 children,there were 20 males and 22 females.The age of onset was 2.7(0.6,5.1)years.Their age at radiofrequency ablation was(6.5±3.6)years,and the weight was(23.4±10.0)kg.Thirty-two children(76%)had sustained AT.The incidence of tachycardia cardiomyopathy was 43%(18/42).Compared to that of the normal cardiac function group,the ablation age and the heart rate at atrial tachycardia of the tachycardia cardiomyopathy group were higher(8.1±3.8)vs.(5.3±3.1)years,t=-2.63,P=0.012;(173±41)vs.(150±30)beats per minute,t=-2.05,P=0.047.Thirty-eight children(90%)responded poorly to two or more antiarrhythmic drugs.The immediate success rate of radiofrequency ablation(RFCA)was 57%(24/42),and the AT recurrence rate was 17%(4/24).Twenty-two children underwent RAA resection,and their AT were all converted to sinus rhythm after the surgery.During the RAA resection,10 cases of right atrial appendage aneurysm were found,9/18 of which failed the RFCA.ConclusionsThe AT originated from the RAA in children tend to present with sustained AT,respond poorly to antiarrhythmic drugs,and has a low success rate of RFCA as well as high recurrence rate.Resection of the RAA is a safe and effective complementary treatment.

关 键 词:心动过速 异位房性 心耳 导管消融术 心脏外科手术 

分 类 号:R725.4[医药卫生—儿科]

 

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