儿童局灶性房性心动过速的射频消融疗效探讨

Effects of radiofrequency catheter ablation in the treatment of focal atrial tachycardia in children

目的 探讨小儿局灶性房性心动过速（房速）的起源位置、电生理特点和射频消融结果.方法 2010年7月至2013年7月清华大学第一附属医院心脏中心小儿科住院接受射频消融的局灶性房速患儿38例,年龄3.0～13.6（7.9＆#177;3.3）岁.分析不同起源位置的局灶性房速射频消融效果、复发及并发症的发生情况,对比不同年龄组射频消融效果.结果 38例患儿中20例（20/38,52.6％）为无休止性房速,18例（18/38,47.4％）为阵发性房速.38例患儿中的12例（31.6％）并发心动过速性心肌病,其中10例（10/12,83.3％）继发于无休止性房速.房速起源部位以心耳部位最为多见（12/38,31.6％）,其次依次为肺静脉（7/38,18.4％）、心房壁（7/38,18.4％）、房间隔（7/38,18.4％）、冠状静脉窦口（3/38,7.9％）、上腔静脉（1/38,2.6％）、三尖瓣环（1/38,2.6％）.38例患儿中的36例（36/38,94.7％）射频消融成功,复发10例（10/36,27.8％）.复发病例中7例（7/10,70.0％）为心耳起源,外科手术将患侧心耳切除后均未再复发.18例（18/38,47.4％）发病年龄≤3岁,20例发病年龄＞3岁;≤3岁组和＞3岁组无休止性房速的发生率、心动过速性心肌病的发生率及起源部位的比例差异无统计学意义.结论 ①对于抗心律失常药物治疗无效的小儿局灶性房速患者,射频消融是安全且有效的治疗方法;②小儿局灶性房速以起源于心耳最为常见;③起源于心耳部位的局灶性房速复发率与失败率最高,外科心耳切除术为安全有效的补充根治方法;④小儿无休止性局灶性房速更易进展为心动过速性心肌病.

Objective To investigate the origin sites of focal atrial tachycardia （FAT） and its electrophysiological characteristics and the radiofrequency catheter ablation （RFCA） outcomes in children.Methods Thirty-eight children with FAT received RFCA under Carto system in our electrophysiology laboratory （EPL）,age 3.0-13.6 （7.9＆#177;3.3） years.RFCA outcomes,recurrences and complications were retrospectively analyzed.RFCA outcomes in different ages and different origin sites were compared.Results Of the total 38 FATs,20 （20/38,52.6%） were incessant,18 （18/38,47.4%） were paroxysmal.Of the 38 children,12 （12/38,31.6%） presented with tachycardia-induced cardiomyopathy （TIC）,10 of them （10/12,83.3%） were secondary to the incessant FATs.Most ofthe FATs were originated from atrial appendage （12/38,31.6%）,followed in turn from the pulmonary vein （7/38,18.4%）,the wall of atrium （7/38,18.4%）,the atrial septum （7/38,18.4%）,the ostium of the coronary sinus （3/38,7.9%）,the superior vena cava （1/38,2.6%） and the tricuspid annulus （1/38,2.6%）.Ablation was acutely successful in 36 children （36/38,94.7%）,10 （10/36,27.8%） recurred.Seven （7/10,70.0%） of the recurrent FATs were originated from the atrial appendage,and all of them were terminated by excision of culprit atrial appendage.In 18 （18/38,47.4%）children,the initial episode of FATs occurred before or at the age of 3 years.In 20 children,the initial episode of FATs occurred after the age of 3 years.The occurrence of incessant FAT,the incidence of TIC and the proportion of the origin sites distributing between ≤3 years group and 〉3 years group were not significantly different.Conclusion ①Ablation was safe and effective for drug resistant FAT in children.②The FAT was most often originated from atrial appendage.③The recurrence rate of FAT and the RFCA failure rate were all high in patients with FAT originating from atrial appendage.Appendectomy for recrudescent FAT originating from atrial appendage was effective.④Incessant FAT in children more easily progressed to TIC.