[儿童房室结折返性心动过速：高频导管消融术的根治性治疗]

[Atrioventricular nodal reentry tachycardia in children: curative treatment by high frequency catheter ablation].

作者信息

Kriebel T, Bertram H, Windhagen-Mahnert B, Bökenkamp R, Kaulitz R, Rohloff A, Peuster M, Hausdorf G, Paul T

机构信息

Abteilung Kinderheilkunde III, Medizinische Hochschule Hannover.

出版信息

Z Kardiol. 2000 Jun;89(6):538-45. doi: 10.1007/s003920070226.

DOI:10.1007/s003920070226

PMID:10929439

Abstract

BACKGROUND

Atrioventricular nodal reentrant tachycardia (AVNRT) is one of the most common forms of supraventricular tachycardia in the pediatric population.

PATIENTS AND METHODS

41 children with a mean age of 9.6 (3.7-16) years with recurrent atrioventricular nodal reentrant tachycardia (AVNRT) refractory to medical treatment (n = 38) and recurrent syncope (n = 3) underwent electrophysiologic (EP) study. In all patients dual AV-nodal physiology could be demonstrated during EP study and typical form of AVNRT (mean heart rate 220/min) could be induced by programmed atrial stimulation. A steerable 7 F ablation catheter was placed at the inferoparaseptal region of the tricuspid valve annulus close to the orifice of the coronary sinus with the intention to record a late fractionated local atrial electrogram during sinus rhythm. Starting at this point radiofrequency current (500 kHz) with a target temperature of 70 degrees C was delivered with the intention to ablate the slow pathway. If a slowly accelerated junctional rhythm (< 120/min) occurred during energy discharge, programmed atrial stimulation was repeated. Otherwise radiofrequency current was delivered step by step up to a septal position next to the tricuspid valve annulus. Slow pathway ablation was defined as lack of evidence of dual AV nodal pathways during repeated atrial stimulation. Slow pathway modulation was defined as maximal one atrial echoimpulse after ablation.

RESULTS

The number of energy applications ranged from 1-19 (median 6). In 35/41 patients slow pathway ablation could be achieved; in six patients the slow pathway was modulated. In none of the patients permanent high grade AV block was observed. During follow-up (mean 4.1 years) two patients had a recurrent episode of AVNRT after slow pathway modulation. All other patients are still free of AVNRT without medical treatment.

CONCLUSION

Selective radiofrequency current ablation/modulation of the slow pathway is a safe and curative treatment of AVNRT in young patients.

摘要

背景

房室结折返性心动过速（AVNRT）是儿科人群中最常见的室上性心动过速形式之一。

患者与方法

41例平均年龄9.6（3.7 - 16）岁的儿童，患有复发性房室结折返性心动过速（AVNRT）且药物治疗无效（n = 38）以及复发性晕厥（n = 3），接受了电生理（EP）研究。在所有患者的EP研究中均证实存在双房室结生理现象，且通过程控心房刺激可诱发典型形式的AVNRT（平均心率220次/分钟）。将可操控的7F消融导管置于三尖瓣环的下间隔区域靠近冠状窦口处，目的是在窦性心律时记录晚期碎裂的局部心房电图。从此处开始，输送频率为500kHz、目标温度为70℃的射频电流，旨在消融慢径路。如果在能量释放过程中出现缓慢加速的交界性心律（<120次/分钟），则重复进行程控心房刺激。否则，逐步将射频电流输送至靠近三尖瓣环的间隔位置。慢径路消融定义为在重复心房刺激时双房室结径路证据消失。慢径路改良定义为消融后最多出现1个心房回波冲动。