导管消融治疗儿童右心室非流出道早搏及室性心动过速

Catheter ablation of premature ventricular contractions and ventricular tachycardia originating from right ventricular non-outflow tract in children

目的 探讨三维标测指导儿童右心室非流出道室性早搏（室早）/室性心动过速（室速）射频消融治疗的有效性及安全性.方法2010年1月至2016年7月于北京儿童医院接受射频消融治疗的室早/室速患儿共261例,选择起源于右心室非流出道的12例（4.6%）患儿（男7例）,年龄2~14 （7.1±3.1）岁.所有患儿均无明显器质性心脏病.7例左心室扩大,3例以单发室早为表现者左心室射血分数（LVEF）〈55%;其中2例（2.5岁及8岁）以持续性室速为主要表现者左心室重度扩大,LVEF均〈40%.所有患儿均采用三维标测系统指导射频消融.结果12例患者术中共出现14种室早/室速,均源自右心室非流出道,其中起源于三尖瓣环6种、游离壁基底部5种、近心尖部2种、右心室间隔近希氏束区域1种.11例即刻消融成功.平均随访（9.2±3.5）个月,11例消融即刻成功者均无复发.1例室速消融未成功者继续服用胺碘酮,仍为室速,但室速频率由160次/min降至130次/min.因此,消融总成功率为11/12（91.7%）.随访中所有消融成功的患儿超声心电图和胸片证实心脏左心室大小、LVEF在6个月内均恢复正常.结论 右心室非流出道室早/室速发作频繁可能损害左心功能.三维标测引导下的射频消融治疗儿童无明确器质性心脏病的右心室非流出道室早/室速有效、安全.

Objective This study aimed to evaluate the efficacy and safety of catheter ablation for pre-mature ventricular contractions（PVCs） or ventricular tachycardia（VT） originating from right ventricular non-outflow tract （RVNOT） in pediatric patients. Methods Twelve children[mean ages were（7.1±3.1） years, 7 males] with RVNOT PVCs/VT underwent catheter ablation.Seven patients had enlarged left ventricle（LV）, and 3 patients had decreased left ventricular （LV） ejection fraction （LVEF）〈55%. Among them,2 with VT （2.5 years old and 8 years old,respectively） had severe dilated LV and both had LVEF〈40%. All the patients had catheter ablation under the guidance of the three-dimensional mapping. Results A total of 14 PVCs/VT occurred,and all originated from RVNOT. The PVCs/VT originated from tricuspid annulus in 6,basal free wall in 5,near apex in 2,and septal portion near HIS bundle in 1. Catheter ablation was immediately successful in 11 patients with PVCs/VT without any complications. During a follow-up period of（9.2±3.5） months,11 pa-tients had no PVC/VTs recurrence. One patient had intermittent VT recurrence with oral amiodarone and the VT rate was decreased from 160 bpm to 130 bpm.Ablation was successful in 11/12（91.7%） patients.And all chil-dren with severe dilated LV before ablation had normal LV diameter. Conclusion Our preliminary data showed that catheter ablation under the guidance of three-dimensional mapping is effective and safe for treatment of RVNOT PVCs/VT in pediatric patients.