儿童右侧旁道164例临床分析及消融效果

The curative efficacy of radiofrequency catheter ablation and clinical study of 320 children with right-sided accessory pathways

目的探讨小儿右侧旁道的临床特点及射频消融效果。方法对2000年3月至2013年9月于我中心拟行射频消融的164例儿童右侧旁道患者进行分析。结果 164例患儿（年龄8个月~19岁）中,显性旁道65例,其中5例合并先天性心脏病;4例合并扩张型心肌病;6例超声提示室壁运动异常和/或左室扩大。157例患者行射频消融治疗,总体消融成功率为98.7%,2例合并右室双出口的患者消融失败。4例合并扩张型心肌病的患者经成功射频消融后心脏射血分数恢复至正常,左室舒张末径回缩至接近正常。6例合并室壁运动异常及左室扩大的患者消融后恢复正常。结论儿童右侧旁道可能合并器质性心脏病,显性心室预激亦可能导致室壁运动异常及左室扩大,因此,消融术前应常规行超声心动图检查。儿童右侧旁道行射频消融术是安全、有效的方法,若合并先天性心脏病,消融难度加大。应用Swartz鞘辅助消融右侧游离壁旁道时,可提高消融成功率,减少复发。

Objective To analyze the clinical features of right-side accessory pathways in children and investigate their curative efficacy of radiofrequency catheter ablation. Methods 164 consecutive pediatric patients, with right-side accessory pathways（APs）, hospitalized in our center between March 2000 and September 2013, were included in this study. Results 164 patients aged from 8 months to 19 years old. 65 patients had overt APs. Five patients had congenital heart disease（CHD）. Four patients had dilated cardiomyopathy. Echo indicated abnormal ventricular wall motion and/or left ventricle enlargement in 6 patients. Ablation successful rate was 98.7%. Unsuccessful ablations were executed in 2 patients with CHD. 4 patients with DCM received successful RFCAs. Echo demonstrated that their left ventricular ejection fraction（LVEF） recovered to normal and diastolic left ventricular internal dimension（LVEDD） decreased to almost normal gradually during the follow-up. Six patients with abnormal ventricular wall motion and/or left ventricle enlargement gain total recovery through RFCA. Conclusions Pediatric patients with right-sided APs may combine with organic heart disease. Overt ventricular preexcitation may result in abnormal ventricular wall motion and left ventricle enlargement. Therefore, echo was necessary for these patients before ablation. RFCA was safe and effective to pediatric patients diagnosed with right-sided APs. When combined with CHD, these patients had more difficulties to gain successful ablation. Swartz sheaths can help to increase the success rate and decrease the recurrence rate when ablating right-sided free wall APs.