无器质性心脏病儿童房性心动过速的射频消融治疗

Radiofrequency catheter ablation of atrial tachycardia in children without structural heart disease

目的探讨无器质性心脏病儿童房性心动过速(房速)的电生理学机制、靶点标测和射频消融疗效。方法46例房速患儿行心内电生理检查和射频消融术,房速靶点标测采用激动标测方法,4例患儿采用三维电解剖学标测系统(CARTO系统)标测和指导消融。消融采用预设温度50～60℃。结果46例患儿均经电生理检查证实为局灶性房速,分别表现为短阵自限性、阵发持续性和持续无休止性心动过速,其中1例合并房室结折返性心动过速。射频消融成功41例,其中单一源性房速39例(右房27例,左房12例),多源房速2例,成功率为89%。结论无器质性心脏病儿童房速的射频消融成功率较高,是一种安全有效的方法。

Objective To investigate electrophysiologic characteristics, the original site of atrial tachycardia （AT） and the results of radiofrequeney catheter ablation （RFCA） in children without structural heart disease. Methods Electrophysiologie study and RFCA were performed in 46 children with AT. The site of origin of AT was mapped by using activation mapping during tachycardia. Magnetic electroanatomieal mapping （CARTO system ） for ablation of atrial tachycardia was performed in 4 patients. Preselecting a temperature of 50 - 60 °C was selected for ablation. Results Electrophysiologic study verified that the mechanism of all the tachycardias in 46 children was focal AT, which might be short paroxysmal, paroxysmal or persistent. 1 child also had atrioventricular nodal reentrant tachycardia. ATs were successfully ablated in 41 children （89%）, in which 39 had one original site （27 foci in right atrium and 12 foci in left atrium）, 2 had at least two original sites. Conclusion The success rate of RFCA in ATs of children without structural heart disease was relatively high. Atrial taclyeardia could be eliminated by radiofrequency current with safety and efficacy.