三维标测系统指导儿童心律失常射频消融治疗

目的探讨Carto系统和Ensite系统标测指导儿童心律失常射频消融(RFCA)的有效性、安全性。方法 22例心律失常患儿,包括9例房性心动过速(AT),4例房室折返性心动过速(AVRT),5例右室室性早搏(PVC),4例特发性室性心动过速(IVT),在Carto系统或Ensite系统三维标测导航下行RFCA治疗。结果所有病例均能准确找到消融靶点,消融完毕后心动过速均未能诱发,术中无发生严重并发症。所有病例平均随访6～24个月,Ensite Array系统组1例AT病例复发,可用药物控制。结论 Carto系统和Ensite系统标测指导儿童心律失常RFCA治疗安全可行,尤其适合于疑难复杂、血流动力学不稳定或不持续的心律失常的RFCA治疗。     

三维标测系统指导下儿童房室结折返性心动过速的零透视射频导管消融

目的探讨与常规标测相比,三维标测系统指导下儿童房室结折返性心动过速的零透视射频导管消融的可行性。方法随机选取2010年1月至2018年1月,在首都医科大学附属北京儿童医院行射频消融术并确诊为房室结折返性心动过速的100例患儿,50例为研究组(应用En Site Velocity~(TM)三维标测系统完成零透视消融),50例为对照组(X线透视消融)。比较两组间的射频消融成功率、并发症发生率、复发率、X线辐射剂量及手术时间。结果两组手术的成功率、并发症发生率及复发率、手术时间差异均无统计学意义,研究组辐射剂量为0,明显低于对照组(75.68±18.02 m Gy)(P0.001)。结论与常规标测相比,儿童房室结折返性心动过速的射频消融术采用En Site Velocity~(TM)标测系统指导完成零透视射频导管消融具有相近的成功率并安全可行。     

儿童特发性室性心动过速经改进的导管标测消融方法治疗体会

总结应用改进的标测方法和新技术治疗儿童特发性室性心动过速的经验。左室特发性室性心动过速(ILVT)共7例 ,其中ILVT时体表12导联心电图表现为完全右束支阻滞伴左前分支阻滞6例和伴左后分支阻滞1例 ;右室特发性室性心动过速(IRVT)3例 ,其中右室流出道2例和右室流入道1例。年龄8.4±3.2岁 ,体重28.5±13.4kg。①在窦性心律下浦肯野电位法标测ILVT消融靶点 ;②应用二根分别放置在右室流出道和右室流入道电极 ,采用“蛙跳”方法标测较早的心室激动点 ,然后用射频导管在该点附近标测IRVT时最早心室激动点 ;③应用Carto系统标测ILVT。结果显示 ,10例均成功消融 ,放电和透视时间分别为7.0±3.8次和20±8.4分钟 ;应用Carto系统标测2例ILVT ,1例ILVT在靶点附近标测过程中易出现室性早搏 ,难与ILVT鉴别而形成错误的电解剖图 ,导致消融失败。提示改进的标测方法可减少放电次数 ,缩短X线透视时间 ;Carto系统在ILVT(VT时体表12导联心电图表现为完全右束支阻滞伴左前分支阻滞或左后分支阻滞)标测过程中易受室性早搏干扰 ,形成错误的电解剖图而消融失败 ,且费用昂贵和手术时间长     

射频消融治疗阵发性室上性心动过速20例

目的 探讨射频消融治疗反复发作的儿童阵发性室上性心动过速(室上速)的疗效和并发症.方法 20例患儿经食管心房调搏诊断为室上性心动过速,并在术前行心内电生理检查,然后标测部位再行射频消融治疗,术后定期随访观察其效果、复发情况和并发症的发生.结果 20例室上速房室折返(AVRT)12例,房室结折返(AVNRT)8例.治疗全部成功,平均X线曝光时间28(15～60) min,发生一过性房室传导阻滞2例(10.0%),复发的3例(15.0%)经再次消融后未再复发,随访1～8 a未见其他并发症.结论 射频消融治疗儿童室上速安全可靠,近期可出现短暂的房室传导阻滞,远期未见明显并发症.     

射频消融在儿童和青少年心律失常中的初步应用

目的：　观察射频消融 (RFCA)对儿童和青少年心律失常治疗的疗效。方法：　对42例患者用射频消融治疗心律失常,心律失常病史为1～9年,平均(5 .3± 1.2 )年。旁路消融在窦律、心室起搏或诱发房室折返性心动过速(AVRT)后,寻找最早心室激动点(EVA)或最早心房激动点(EAA) ;房室结折返性心动过速 (AVNRT)以后位或下位法标测靶点;室性心动过速(VT)和室性早搏(PVC)以起搏标测和激动标测相结合;心房扑动(AFL)行连续性线性RFCA ;心房颤动 (AF)行房室结慢径改良。结果：　 42例患者行RFCA ,成功 40例,1例AF患者行房室结改良时并发Ⅲ度房室传导阻滞(Ⅲ°AVB) ,术后2周未恢复,植入永久起搏器。结论：　RFCA对儿童和青少年心律失常的治疗有效而安全,但应严格掌握适应证     

儿童快速房性心律失常的射频消融治疗

对传统方法和CARTO系统在指导导管射频消融儿童快速房性心律失常中的临床应用作初步探讨 ,前者为局灶性房速常规采用激动标测方法 ,后者则应用CARTO系统分别标测I型房扑和房缺在术后疤痕介导房内折返性房性心动过速靶点 ,并在房扑消融后重建三维电解剖图 ,判定峡部完全双向传导阻滞。结果显示3例成功消融 ,曝光时间(18±9)min。随访1月～3月无复发。由此经临床证实导管射频消融儿童快速房性心律失常安全有效 ,尤其对复杂快速房性心律失常 ,CARTO系统能在较少X线曝光下 ,易于标测和成功消融。     

射频消融分支电位治疗儿童左后分支性室性心动过速

目的 简化经导管标测和消融儿童左后分支性室性心动过速的方法.方法 窦性心律下,在后间隔(冠状静脉窦口下缘1～2 cm)的区域内,标测分支电位,其表现为心室波之前的双向波,两者之间存在明确的等电位线;当消融导管标测该电位较希氏柬电位晚20ms以上时试放电;放电前双角度(LAO 45°和30°)观察消融导管的位置,确定不在希氏束处;心电图出现左后分支阻滞,说明消融有效.消融术后心电监测24～48 h,注意室速终止后复极变化;服阿司匹林2～3 mg/kg 3个,月,停服抗心律失常药物,术后1d复查体表心电图、胸片、超声心动图,出院后1个月、3个月各随访一次,此后每半年门诊定期复查或电话随访.结果 15例患儿成功消融,术后心电图均出现左后分支阻滞图形;随访3～12个月,所有出现左后分支阻滞的患儿均无复发.其中1例术中靶点位置好的患儿,试放电后,心电图无改变,仍出现室速,后重新标测,试放电后出现左后分支阻滞,巩固90 s,成功消融,随访6个月,无复发.结论 射频消融分支电位治疗儿童左后分支性室性心动过速,简化了标测,减低了手术的难度,消融终点更为可靠.     

射频消融术治疗小儿间隔部位心动过速的临床研究

目的　通过回顾 98例心动过速患儿在间隔部位的放电消融过程 ,总结儿童间隔部位射频消融术的经验。方法　 98例心动过速患儿 ,平均年龄 ( 8 1± 2 3)岁 ,体重 ( 2 8± 9)kg ,房室结内折返性心动过速 (AVNRT) 6 2例、间隔部位房室折返性心动过速 (AVRT) 2 5例、Koch三角内房速 (AT)3例和左室间隔部室性心动过速 (ILVT) 8例。常规行心内电生理检查 (EPS)和射频消融术 (RFCA)。右侧消融可视情况使用Swartz长鞘 ,帮助固定到位温控射频导管。在窦性心律时采取“能量滴定”和“时间递增”法放电消融。即放电时可采用逐渐增加输出功率及放电时间的方法。结果　 98例全部成功消融 ,终止了心动过速。 11例 ( 11% )术后复发性心动过速 ,10例再次行射频消融术也成功终止了发作。并发症 :1例后间隔部AVRT术中出现Ⅲ度房室传导阻滞 (AVB) ,不能恢复正常心律 ,2周后放置心内膜永久起搏器。结论　儿童间隔部位范围狭小 ,心内膜层薄 ,房室结较脆弱 ,术中稍有不慎 ,易造成不可逆转的Ⅲ度AVB。所以在儿童间隔部位行EPS和RFCA要慎重。采用如下操作方法可减少儿童病例射频消融术中的失误 :( 1)操作轻柔 ;( 2 )窦性心律放电 ;( 3)采用“能量滴定”和“时间递增”法 ;( 4 )加用Swartz长鞘固定射频导管 ;( 5 )采用温控导管 ;(     

射频导管消蚀治疗小儿特发性室性心动过速

应用射频导管消蚀（ＲＦＣＡ）治疗４例小儿特发性室性心动过速（ＩＶＴ），旨在探讨ＲＦＣＡ对小儿ＩＶＴ的疗效。采用起搏标测法对室性心动过速（ＶＴ）进行标测和消蚀。经上述方法消蚀失败的左室间隔下部ＶＴ改用束支改良法，３例消蚀成功。随访１７～２０个月，１例复发，经再次消蚀成功。提示，射频消蚀可有效治疗小儿特发性室性心动过速。     

心内接触与非接触性标测指导导管消融术治疗儿童频发室性早搏

目的比较心内接触与非接触性标测在指导儿童频发室性早搏导管消融术中的优越性、安全性和适应证的选择。方法研究对象为2002年8月至2008年6月广东省人民医院收治的8例无器质性心脏病的频发室性早搏患儿,24h室早总数平均(30000±8465)个。采用Ensite非心内接触性标测系统指导消融4例,年龄10～14岁,右室流出道2例,右室流入道2例;传统心内接触性标测指导消融4例,年龄6～10岁,右室流出道2例,右室流入道1例,左室流出道1例。术前和术后1、3个月记录24h室早总数,记录两种方法的X线曝光时间、并发症和适应证。结果两种方法术后均获即刻成功,无并发症发生,7例术后1、3个月室早总数0～5个/24h,其中1例左室流出道室早复发,先后2次消融成功;X线曝光时间右室流出道:16.5min vs 32.5min,右室流入道:26.5min vs 60min,心内接触性标测消融左室流出道室早:90min。结论EnSite非接触性三维标测较接触性标测下消融有许多优越性,但同样也存在着局限性,心内接触性标测适应性广,是非接触性三维标测的基础和补充,尤其在EnSite非接触性三维标测标测失败时。     

��ά���ϵͳָ���¶�ͯ���ҽ��۷����Ķ����ٵ���͸����Ƶ��������

??Objective??To explore the feasibility of zero-fluoroscopy radiofrequency catheter ablation??RFCA?? for pediatric atrioventricular nodal reentrant tachycardia??AVNRT?? using three-dimensional mapping compared with conventional mapping. Methods??We randomly selected 100 patients with AVNRT who received RFCA in Beijing Children’s Hospital from January 2010 to January 2018??50 patients used three-dimensional mapping for Zero-fluoroscopy RFCA??EnSite Velocity™ Cardiac Mapping System????group A?? and 50 patients used conventional mapping??group B??. Comparisons of RFCA success rate??complication rate??recurrence rate??and total fluoroscopy dose between group A and group B were made. Results??Success rate??complication rate??recurrence rate and total procedure time were not significantly different between the two methods. Total fluoroscopy dose was significantly reduced in group A compared with group B??0 mGy vs. ??75.68±18.02?? mGy??P??0.001????. Conclusion??Compared with conventional mapping??using EnSite Velocity™ Cardiac three-dimensional mapping in RFCA for pediatric AVNRT can complete zero-fluoroscopy dose with similar success rate and safety.     

Ventricular tachycardia in nonpostoperative pediatric patients: role of radiofrequency catheter ablation

Experience concerning radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in pediatric patients is limited. In adults, success rates vary widely based on the etiology of the VT. Highest success rates have been achieved in patients without structural heart disease. Between March 1998 and December 1999, five young patients (age, 5 months to 15 years; body weight, 5.5-61.6 kg) underwent RFCA for VT at our institution [structurally normal heart (n = 4), preoperative tetralogy of Fallot (n = 1)]. Monomorphic VT was present in four children, and an infant with MIDAS syndrome had polymorphic VT. Clinical presentation varied: palpitations, n = 2, congestive heart failure, n = 3. All patients had been proven to be unresponsive to one to six (median, three) antiarrhythmic drugs. In all five patients, VT could be successfully eliminated by RFCA after a total of nine (range, 1-4) procedures. Activation mapping and pace mapping were used to identify the anatomical substrate, which was located in the right ventricle/right ventricular outflow tract in all four patients with monomorphic VT and in the left ventricular septum/left ventricular free wall in the infant with polymorphic VT. There were no significant complications in any patient. During follow-up (20-42 months), all patients are in normal sinus rhythm. Left ventricular function recovered in all three patients who had initially presented with congestive heart failure. RFCA can be effective, safe, and life saving in children with medically resistant VT who have not been operated on for congenital heart disease, even when the VT is polymorphic. Although the number of patients is small, RFCA may be the treatment of choice for symptomatic VT in pediatric patients.     

Effectiveness of Radiofrequency Catheter Ablation of Outflow Tract Ventricular Arrhythmias in Children and Adolescents

Outflow tract ventricular arrhythmias (OTVAs) are common in children; however, experience is limited on their radiofrequency catheter ablation (RFCA). The purpose of this study was to assess the outcomes of mapping and ablation of pediatric OTVAs and to evaluate the role of ECG algorithms in distinguishing the origin of OTVAs. We compared retrospectively collected single-center data on 92 consecutive pediatric patients (58 male; age, 8.2 ± 2.9 [range 3.6–18] years) who underwent RFCA for OTVAs from 2009 to 2015. Two independent and blinded observers analyzed ECG data. Of these children, 69 (75 %) were of RVOT origin. RFCA was given up in 1 case, and the acute success rate was 92.3 % (84/91), the 1-year follow-up recurrence rate was 8.3 % (7/84) and the complications of the procedure were 2.2 % (2/92). And 3D versus 2D mapping-guided RFCA was associated with significantly (p < 0.05) higher acute success rate (96.1 % [49/51] vs. 87.5 % [35/40]), and lower X-ray exposure (742.5 ± 323.1 vs. 1432.3 ± 605.5 mGy cm²) and 1-year recurrence rate (4.1 % [2/49] vs. 14.3 % [5/35]). The positive predictive value of four types of ECG algorithms used in adults for LVOT origin was only 47.7–65.4 %. In these cases, four identified as RVOT origin and two identified as LVOT origin by ECG underwent successful ablation on the other side of outflow tract finally. And these six children who underwent successful RFCA in both sides of outflow tract had no follow-up recurrence. OTVAs in children originate mostly from RVOT. RFCA can be used for ablation of pediatric OTVAs effectively and safely. In some cases, successful RFCA should be ablated in both sides of outflow tract. ECG-based prediction of OTVA origin as used in adults is limited in children.     

射频消融术围术期儿童血浆D-二聚体检测的意义

目的 探讨儿科射频导管消融术(RFCA)对凝血状态的影响,观察D-二聚体在RFCA围术期血浆水平变化及其临床意义.方法 选择2003年12月-2005年12月本院行RFCA的快速心律失常患儿30例.男12例,女18例;年龄7～13岁.分别在插管前、电生理标测后、RFCA成功即刻、术后2、7 d采集血样本1.8 mL,3 000 r/min,离心10 min,获得上层血浆低温保存,用ELISA检测其血浆D-二聚体水平.采用SPSS 12.0软件对资料行配对t检验.结果 D-二聚体在RFCA成功即刻水平最高,术后7 d基本恢复到插管前水平.对本组进行的成组资料配对比较中发现,D-二聚体除插管前与术后7 d及电生理标测后与术后2 d无显著差异外,其他各组比较均有统计学意义(Pa＜0.01).结论 儿科RFCA具有术中、术后高凝状态的病理基础,而D-二聚体的水平变化的检测有利于对RFCA引起的血栓栓塞事件进行及时预报,以指导抗凝药物的应用和避免临床不良事件的发生.     

Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Children and Adolescents

The objective of this study is to provide results and costs of catheter ablation in children and adolescents in a low-income country. Reports from first-world countries have demonstrated the cost-effectiveness of radiofrequency catheter ablation (RFCA) compared to medical treatment of supraventricular tachycardia (SVT). The study included 28 patients younger than 18 years of age with SVT in a pediatric cardiology unit in Guatemala. All patients underwent RFCA. Clinical outcome and cost-effectiveness of RFCA compared to continued medical treatment were the end points. Twenty-four patients had successful ablation (85.7%). Mean age at RFCA was 11.42 ± 3.49 years. Three patients underwent a second ablation, increasing the success rate to 96.4%. One remaining patient is awaiting a second procedure. At a mean follow-up of 13.69 ± 7.16 months, all 27 patients who had a successful ablation remained in sinus rhythm. Mean cost per procedure was 4.9 times higher than that of medical treatment. However, the estimated cost of catheter ablation equal that of medical therapy after 5.1 years and is 3.4 times less after 20 years. Radiofrequency catheter ablation of SVT in children and adolescents is safe and cost-effective compared to medical therapy. Resources must be judiciously allocated, especially in low-income countries, to treat the largest number of pediatric patients.     

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

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。     

经导管射频消融治疗儿童间隔旁道的安全性及有效性

目的:评估儿童间隔旁道射频消融的有效性及安全性。方法:2013年9月至2019年3月因阵发性室上性心动过速于上海交通大学医学院附属上海儿童医学中心心内科住院拟行经导管射频消融治疗共626例患儿,对其中74例间隔旁道患儿的临床及射频消融数据进行分析。结果:74例患儿中,男45例,女29例;年龄(7.8±3.5 )岁(10...     

婴儿房室旁路的射频消融术8例病例系列报告

摘要目的：评价射频消融术治疗婴儿房室旁路的疗效和安全性。 方法：回顾性收集2015年1月1日至2019年6月30日在复旦大学附属儿科医院（我院）接受射频消融手术治疗的药物难治性房室旁路婴儿的临床资料。手术指征包括药物难治性房室折返性心动过速或预激性心肌病。手术操作采用改良低辐射剂量影像策略下的二维标测与消融技术。 结果：共纳入8例患儿,年龄中位数6.5月,体重中位数7.7 kg。术中电生理检查证实7例存在1条旁路,1例存在2条旁路;其中右侧壁旁路5条,左侧壁旁路3条,左后间隔旁路1条;4例表现为Wolff-Parkinson-White综合征,4例为隐匿性旁路。透视时间中位数11.2 min,辐射剂量-面积乘积15.7 μGy·m2。手术即刻成功率100%,术后随访时间中位数15月,无心动过速复发。1例出现迟发性二尖瓣后叶穿孔并成功接受手术修补,未观察到其他并发症。结论：射频消融术可有效治愈房室旁路所导致的婴儿药物难治性心律失常,但需谨慎把握其适应证,并进行适当操作改良,以尽可能避免消融并发症。