小儿特发性室性心动过速标测方法与消融效果的探讨

Relationship between curative efficacy of radiofrequency catheter ablation and mapping methods in children with idiopathic ventricular tachycardia

目的探讨小儿特发性室性心动过速（ＩＶＴ）的标测方法与射频导管消融（ＲＦＣＡ）治疗效果之间的关系。方法起源于右室ＩＶＴ采用起搏标测法；起源于左室间隔部ＩＶＴ采用体表心电图（ＥＣＧ）起搏标测和心内膜激动顺序标测联合标测法。结果经ＲＦＣＡ治疗２０例ＩＶＴ，其中３例ＩＶＴ起源于右室流出道；１５例起源于左室间隔部；２例起源于左室间隔以外部位。首次消融成功１８例，２例失败。３例术后复发，其中２例再次消融获成功，随访至今无复发。起源于左室间隔部位ＩＶＴ，应用起搏标测，虽５例中４例成功，但术后３例复发。采用心内膜标测为基础的联合标测法全部消融成功（１２／１２例），随访至今无复发，且明显缩短了Ｘ线照射时间。结论ＲＦＣＡ可安全、有效地用于治疗小儿ＩＶＴ。

Objective To determine the mapping method of idiopathic ventricular tachycardia (IVT) on the curative efficacy in pediatric patients. Methods Twenty children aged 2 to 14 years with IVT underwent catheter ablation with radiofrequency energy. Sites for radiofrequency energy delivery were selected on the basis of pace mapping of identical (12/12) pace map in IVT located in outflow tract of right ventricle (RVOT). The mapping of the IVT located in left ventricular septum was performed as follows: the QRS configuration during tachycardia, pace mapping and left ventricular endocardial mapping. Results Radiofrequency catheter ablation was successful in eliminating 18/20 VTs, of which 15 VTs originated from the left ventricular septum, 3 VTs from the RVOT and 2 from other sites in the left ventricle. VT recurred in three children but two were successfully treated again with ablation and they have not recurred up to now. Radiofrequency catheter ablation was successful (4/5) by pace mapping, but three recurred; 12/12 VTs were successfully treated by radiofrequency catheter ablation as combined mapping and in none of them VT recurred by now. Conclusion The results of this study demonstrated that radiofrequency catheter ablation of IVT in pediatric patients is safe and effective. The efficacy of the procedure depends on the mapping technique.