中国循证儿科杂志 ›› 2020, Vol. 15 ›› Issue (1): 72-75.

• 论著 • 上一篇    下一篇

婴儿房室旁路的射频消融术8例病例系列报告

王凤1,陈岗2,梁雪村1,吴琳1   

  1. 1 复旦大学附属儿科医院心血管中心 上海,201102;2 上海交通大学附属上海市第一人民医院心内科 上海,200082
  • 收稿日期:2020-02-25 修回日期:2020-02-24 出版日期:2020-02-25 发布日期:2020-03-16
  • 通讯作者: 吴琳
  • 基金资助:
     

Radiofrequency catheter ablation of accessory pathways in infants: A case series report

 WANG Feng1, CHEN Gang2, LIANG Xue-cun1, Wu Lin   

  1.  1 Cardiovascular Center, Children's Hospital of Fudan University, Shanghai 201102, China; 2 Cardiology Department, Shanghai First People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200082, China
  • Received:2020-02-25 Revised:2020-02-24 Online:2020-02-25 Published:2020-03-16
  • Contact: WU Lin
  • Supported by:
     

摘要: 摘要目的:评价射频消融术治疗婴儿房室旁路的疗效和安全性。 方法:回顾性收集2015年1月1日至2019年6月30日在复旦大学附属儿科医院(我院)接受射频消融手术治疗的药物难治性房室旁路婴儿的临床资料。手术指征包括药物难治性房室折返性心动过速或预激性心肌病。手术操作采用改良低辐射剂量影像策略下的二维标测与消融技术。 结果:共纳入8例患儿,年龄中位数6.5月,体重中位数7.7 kg。术中电生理检查证实7例存在1条旁路,1例存在2条旁路;其中右侧壁旁路5条,左侧壁旁路3条,左后间隔旁路1条;4例表现为Wolff-Parkinson-White综合征,4例为隐匿性旁路。透视时间中位数11.2 min,辐射剂量-面积乘积15.7 μGy·m2。手术即刻成功率100%,术后随访时间中位数15月,无心动过速复发。1例出现迟发性二尖瓣后叶穿孔并成功接受手术修补,未观察到其他并发症。结论:射频消融术可有效治愈房室旁路所导致的婴儿药物难治性心律失常,但需谨慎把握其适应证,并进行适当操作改良,以尽可能避免消融并发症。

 

Abstract: Abstract Objective:To evaluate the effectiveness and safety of radiofrequency catheter ablation (RFCA) of accessory pathways (APs) in infants. Methods:Infants younger than 1 year old were evaluated retrospectively, who underwent RFCA in our institution between January 1, 2015 and June 30, 2019. Indications for RFCA included drug-refractory atrioventricular reentrant tachycardia (AVRT) or cardiomyopathy induced by APs. All procedures were performed using a modified low dose imaging protocol of fluoroscopy. Results:A total of eight infants were included, with median age of 6.5 months and weight of 7.7kg. The electrophysiology study confirmed 1 AP in each 7 patients and 2 APs in 1 patient, of which 5 were right lateral; 3 were left lateral and 1 was left posteroseptal. The AP was manifested in 4 patients with Wolff-Parkinson-White syndrome and concealed in another 4 patients. Median fluoroscopy time was 11.2 minutes and dose-area product was 15.7 μGy. m2. The acute success rate was 100%. After the median follow-up period of 15 months, no tachycardia recurred. One patient developed late mitral valve perforation, which was successfully repaired by surgery and no other complications occurred. Conclusion:RFCA could effectively cure infants with drug-refractory arrhythmias induced by APs, however, the indications should be taken seriously and proper procedural modifications might be needed to avoid ablation complications as far as possible.

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