射频消融术治疗儿童快速型心律失常74例

Radiofrequency catheter ablation for tachyarrhythmias in 74 children

目的总结射频消融治疗74例儿童心动过速效果及经验，探讨射频消融治疗儿童快速性心律失常中的安全性及临床疗效。方法2006年3月至2011年12月上海市儿童医院采用射频消融术治疗的74例儿童快速性心律失常，其中男42例，女32例；年龄5～16岁，平均（7．18±3．10）岁；病史0．5～13．0年。术后随访1个月至6年包括：房室结折返性心动过速（AVNRT）12例；房室折返性心动过速（AVRT）51例，其中左旁道、右旁道、心外膜旁道各为26例、23例、2例，其中3例为右侧双旁道，l例为左侧双旁道；房性心动过速8例；特发性室性心动过速3例。结果74例中70例射频消融成功。其中AVNRT12例均消融成功，成功率100％；AVRT51例消融成功49例，成功率96％，包括左旁道消融成功26例（100％）、右旁道21例（91％）、心外膜旁道2例（100％），2例右旁道（术中标测为希氏柬旁路）消融未成功；房性心动过速消融成功6例，成功率75％；1例右室流出道室速术后5年后复发。全组均未出现严重并发症。结论射频消融治疗儿童AVNRTAVRT安全、有效、复发率低；房性心动过速及室性心动过速病例较少，尚须进一步积累病例，总结经验。

Objective To investigate the clinical value and experience of radiofrequency catheter ablation for tachyar- rhythmias in 74 patients.To assess the safety and efficacy of radiofrequency ablation of tachycardia in children.Methods From March 2006 to December 2011,74 procedures of radiofrequency ablation of tachycardia were performed, 42 male, 32 female, aged form 5 to 16 years [ mean age （7.18 ± 3.1 ） years 1,0.5 to 13 years of disease history.The 1 to 6-year follow-up included atrioventricular nodal reentrant tachycardia （AVNRT） in 12 children, atrioventricular reentrant tachycardia（AVRT） in 51 children, atrial tachycardia in 8 children, and idiopathic ventricular tachycardia in 3 children. Four patients （8%） had two pathways.There were 26 left-sided accessory pathways and 23 right-sided accessory path- ways, 2 Kent-His bundle accessory pathways.Results Totally 70 patients were successfully ablated; 12 patients with AVNRT were all successfully ablated, and acute ablation success were achieved in 100% of patients with AVNRT; 49 patients with AVRT were successfully ablated in 51 cases, the success rate being 96%.Success rate of left-sided acces- sory pathway ablation was higher than the right-sided accessory pathway （ 100% vs 91% ）. Two patients with atrial tachy- cardia and 2 patients with epicardium accessory pathways failed, the success rate being 75% of patients with atrial tachy- cardia.One patient with ventricular tachycardia had recurrence after 5 years.Serious procedure complications did not oc- cur in all patients.Conclusion Our experience indicates that radiofrequency ablation is a safe and effective treat- ment for supraventricular tachycardia in children, recurrence rate is very low, and we have small number of atrial tachy- cardiac cases and ventricular tachycardia cases, which require further accumulation of cases to summarize experience.