儿童左室特发性分支性室性心动过速的射频消融治疗

Radiofrequency catheter ablation of idiopathic left fascicular ventricular tachycardia in children

目的报道射频导管消融治疗儿童左室特发性分支性室性心动过速(ILFVT)的有效性及安全性。方法本中心2000年6月至2019年4月射频导管消融治疗30例儿童ILFVT,年龄1~14岁,男性12例,女性18例。常规心内电生理检查明确ILFVT诊断后经X线二维或CARTO三维系统引导标测消融,消融靶点为心动过速时左室间隔部标测最早激动处或窦性心律时左室间隔部最早Purkinje电位或舒张期电位处。结果 29例诊断为左后分支ILFVT,1例诊断为左前分支ILFVT。经X线引导ILFVT标测消融13例,应用CARTO三维系统引导标测消融17例。CARTO三维标测指导下消融的手术时间、X线曝光时间明显短于X线二维指导下消融,分别为[(30±10)min vs (50±20)min,P<0.05;(5±2)min vs (15±5)min,P<0.05]。30例患者ILFVT均消融成功。随访2年,2例应用X线指引消融ILFVT复发,经再次消融成功。无并发症发生。结论射频消融治疗儿童左室特发性室性心动过速安全、有效。

Objective To report the efficacy and safety of radiofrequency catheter ablation(RFCA) of idiopathic left fascicular ventricular tachycardia(ILFVT) in children. Methods Among the 30 cases of ILFVT treated by RFCA in children or adolescents from June 2000 to April 2019, aged from 1 to 14 years old, including 12 males and 18 females. After the diagnosis of ILFVT was confirmed by routine intracardiac electrophysiological examination, X-ray two-dimensional or CARTO three-dimensional system guided mapping and ablation was performed. The ablation target was the earliest excited site at the left ventricular septum department in tachycardia or the earliest Purkinje potential or diastolic potential at the left ventricular septum in sinus rhythm. The endpoint of RFCA was non-induction of ILFVT by ventricular and atrial stimulations at the end of procedure in a basic state or by intravenous infusion of isoproterenol. Results Twenty-nine cases were diagnosed as left posterior fascicular ILFVT, and 1 case was diagnosed as left anterior fascicular ILFVT. X-ray guided mapping and ablation of ILFVT was performed in 13 cases, and CARTO three-dimensional system guided mapping and ablation was performed in 17 cases. ILFVT ablation was successful in all 30 patients. During 2 years of follow-up, 2 cases of left posterior fascicular ILFVT recurred and were successfully re-ablated. No complications occurred. Conclusion RFCA is safe and effective for ILFVT in children.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(1):23-27]