应用三维标测系统低辐射射频消融治疗儿童心律失常14例分析

Radio frequency catheter ablation of arrhythmias with low dose X-ray guided by three-dimensional mapping system in 14 children

目的探讨应用三维标测系统低辐射射频消融治疗儿童心律失常的可行性及临床效果。方法回顾性分析。选择2017年4月至2018年5月因快速性心律失常在天津市儿童医院住院治疗后转诊至天津医科大学总医院并在三维标测系统引导下行射频消融治疗的14例患儿为研究对象,记录术中电生理检查结果、术中X线使用剂量、射频消融即刻成功率及有无并发症,随访至少6个月观察有无复发。结果14例患儿中室上性心动过速11例,电生理检查证实房室折返性心动过速5例(左侧旁路2例、右侧旁路3例),房室结折返性心动过速4例,心房扑动1例,心房扑动合并房室结折返性心动过速1例,局灶性房性心动过速、室性心动过速及室性早搏各1例。11例患儿手术为零射线完成,3例于X线透视下穿刺房间隔,应用低剂量X线,曝光量分别为3.85、3.23、4.67 mGy。1例右侧旁路的房室折返性心动过速术中并发三度房室传导阻滞,术后25 d恢复正常,余无并发症。随访7~20个月,13例成功,1例房室结折返性心动过速并心房扑动患儿未成功。结论儿童快速心律失常在三维标测系统引导下低辐射射频消融是可行的。

Objective To assess the feasibility and efficacy of radiofrequency catheter ablation(RFCA)of arrhythmias with low dose X-ray in children guided by three-dimensional mapping system.Methods Fourteen children with tachyarrhythmia who were transferred to Tianjin Medical University General Hospital after being hospitalized in Tianjin Children′s Hospital and underwent RFCA from April 2017 to May 2018 were included.The results of intraoperative electrophysiological examination,intraoperative X-ray dosage,the immediate success rateand complications of RFCA,and the recurrence during the follow-up for at least 6 months were recorded.Results Among the 14 children,11 cases were diagnosed with supraventricular tachycardia.Five cases had atrioventricular reentrant tachycardia(AVRT)which included two cases with left accessory pathway and three cases with right accessory pathway,and four cases had atrioventricular nodular reentrant tachycardia(AVNRT),one case had atrial flutter(AFL),one case had both AFL and AVNRT.One case had focal atrial tachycardia,one case had ventricular tachycardia,and one case had premature ventricular contraction.Eleven cases underwent RFCA with zero radiation,and 3 cases underwent atrial septal puncture with low dose X-ray.The exposure amounts were 3.85,3.23 and 4.67 mGy,respectively.No complications occurred except for one case with AVRT had atrioventricular block and recovered to normal in 25 days after operation.During the follow-up of 7 to 20 months,no arrhythmias had been found in 13 cases,and one case with AVRT and AFL recurred.Conclusion Under the guidance of three-dimensional mapping system,RFCA of tachyarrhythmia with low dose X-ray in children is feasible.