心房扑动患儿射频消融治疗及临床资料分析

Clinical features and outcomes of radiofrequency catheter ablation of atrial flutter in children

目的 探讨儿童心房扑动的临床特征以及射频消融治疗特点.方法 病例观察性研究,选自2009年2月至2016年11月在清华大学第一附属医院接受心内电生理检查及射频消融手术的50例心房扑动患儿（男37例,女13例）资料,年龄（6.2±3.5）岁,体重（23.7±13.5） kg;心脏结构正常患儿26例,先天性心脏病（先心病）患儿24例,其中22例为先心病外科矫治术后.射频消融术后随访1个月到7年,分析患儿心房扑动的射频消融以及临床资料.分级资料应用t检验,分类资料应用x2检验.结果 50例心房扑动患儿发病年龄（4.2±3.3）岁.表现为持续性心房扑动42例（84％）,阵发性心房扑动8例（16％）.心房扑动合并病态窦房结综合征18例（36％）.病态窦房结综合征发病率在心脏结构正常组与合并先心病组比较差异无统计学意义[38.9％ （7/18）比61.1％（11/18）,P=0.239 5].接受心房扑动射频消融49例患儿中,即时成功率为96％,随访复发率8％,手术无并发症发生.心脏结构正常的26例均为三尖瓣峡部依赖的大折返心房扑动;先心病外科矫治术后的10例（45％）为单纯三尖瓣峡部依赖的大折返心房扑动,4例（8％）为手术切口折返性心房扑动,8例（16％）为二者均参与形成折返的心房扑动.结论 射频消融是根治儿童心房扑动安全有效的方法.心脏结构正常心房扑动与先心病术后心房扑动射频消融成功率和复发率无差异,病态窦房结综合征的发生率也无差异.先心病术后心房扑动的发生机制可为经三尖瓣峡部的心房内大折返、手术切口折返或二者均参与形成折返.

Objective To explore the clinical features of atrial flutter （AFL） and evaluate the efficacy of radiofrequency catheter ablation （RFCA） for AFL in children.Method Data were collected and analyzed on 50 consecutive pediatric AFL patients （male 37/female 13） who underwent electrophysiology study and RFCA from February 2009 to November 2016 in a case observational study.The average age was （6.2 ±3.5） years and body weight was （23.7 ± 13.5） kg.Heart structure was normal in 26 patients.Twenty-four patients had congenital heart disease （CHD） and among them 22 patients underwent repaired surgery before.Patients were followed-up for 1 month to 7 years after RFCA.Clinical features and the outcomes of RFCA in AFL patients were analyzed.Result The average onset age was （4.2 ± 3.3） years.Of these patients,84% had persistent AFL and 16% paroxysmal AFL.AFL with sick sinus syndrome （SSS） occurred in 36% patients without statistically significant difference between the groups with and without CHD （38.9% （7/18） vs.61.1% （11/18）,respectively,P =0.239 5）;49 patients underwent RFCA except one case with atrial standstill during the procedure.The total acute success rate was 96%.The follow-up recurrence rate was 8%.No complication of the procedures was observed.The cavotricuspid isthmus-dependent AFL occurred in all patients without CHD.However,in the children with CHD after the repair surgery 10 （45%） cases were with cavotricuspid isthmus-dependent AFL,4 （8 %） with atrial scarsdependent AFL,and 8 （16%） with both cavotricuspid isthmus and atrial scars-dependent AFL.Conclusion RFCA was effective and safe for pediatric AFL.There is no difference on the acute success rate,the followup AFL recurrence rate,as well as occurrence of SSS between the groups with and without CHD.AFL patients with CHD included the cavotricuspid isthmus-dependent AFL,atrial scars-dependent AFL or both.