窦性心律下X线影像解剖定位与P电位标测相结合指导小儿左室特发性室性心动过速的射频消融治疗

Radiofrequency catheter ablation of pediatric idiopathic left ventricular tachycardia by X-ray image anatomical location combined with P potential mapping under sinus rhythm

目的探讨窦性心律(简称窦律)下X线影像解剖定位与P电位标测相结合的方法指导射频消融儿童特发性左室室性心动过速(ILVT)的可行性和有效性。方法窦律下X线解剖定位结合P电位标测方法 30例,激动顺序标测法(对照组)25例。比较两种标测方法射频消融的成功率和复发率。结果窦律下X线解剖定位结合P电位标测方法 30例,4例未能诱发ILVT,30例均消融成功,成功率100%。激动顺序标测方法 25例,2例未能诱发ILVT,23例(23/25)成功射频消融治疗,成功率100%。术后随访3个月至13年,前者复发1例(3.3%),后者复发3例(13.0%),两组差异有显著性(P<0.05)。复发病例再行射频消融获成功。全部患儿术后体表心电图均无左后分支阻滞。结论窦律下X线影像定位结合P电位标测方法指导射频消融治疗ILVT成功率高、复发率低且操作简单安全。

Objective To investigate the feasibility and effectiveness of X-ray image anatomical location combined with P potential mapping under sinus rhythm in radiofrequency catheter ablation（RFCA） of pediatric idiopathic left ventricular tachycardia（ILVT）.Methods X-ray image anatomical location combined with P potential mapping under sinus rhythm was performed in 30 children.Activation sequence mapping was performed in 25 children（control）.Compare success rate and recurrence rate of the two mapping methods.Results X-ray image anatomical location combined with P potential mapping under sinus rhythm was performed in 30 children and tachycardias were not induced in 4 of them.RFCA were performed in all of them,with success rate 100%.Activation sequence mapping was performed in 25 children（control） and tachycardias were not induced in 2 of them.RFCA were performed in 23 with 100% of success rate.During follow-up period of 3 months to 13 years,recurrence number of X-ray image anatomical location combined with P potential mapping under sinus rhythm group was 1 case（3.3%）,significantly lower than that of activation sequence mapping group 3 cases（13.0%）.All recurrent cases were cured after the second time of RFCA procedure.Left anterior fascicular block was not detected in any of these patients′electrocardiogram done after RFCA procedures.Conclusion X-ray image anatomical location combined with P potential mapping under sinus rhythm in RFCA of pediatric ILVT is safe and simple with high success rate and low recurrence rate.