Hebe J, Hansen P, Ouyang F, Volkmer M, Kuck K H
Department of Cardiology, St. Georg Hospital, Lohmühlenstrasse 5, D-20099 Hamburg, Germany.
Pediatr Cardiol. 2000 Nov-Dec;21(6):557-75. doi: 10.1007/s002460010134.
Patients with anomalies of the heart frequently suffer from arrhythmias that either are associated with a congenital heart defect or result from the course of the disease. For most of the bradyarrhythmias, appropriate timing of the initiation of treatment is more challenging than its eventual execution. In the case of tachycardias, technical aspects of treatment require more attention because the often imperative impact such tachycardias have on quality of life, morbidity, and mortality determine intervention timing. Increasingly, interventional electrophysiology is turned to as a potentially definitive and substrate-related treatment because of antiarrhythmic drug therapy's failure to prevent arrhythmia recurrences and the potential detrimental side effects from drug therapy seen in this particular patient population. Using the experience gained during the past 10 years in the treatment of patients with arrhythmias but without associated structural heart disease, several groups reported their results and difficulties with the application of such therapy to patients with congenital heart defects. In this report, we summarize our hospital's experience with transcatheter radiofrequency current application for treatment of various types of tachyarrhythmias in 139 children and adults with congenital heart defects, emphasizing the current limitations of such therapy and addressing the potential benefits expected from future technology. Patient ages ranged from 5 months to 76 years (mean 25.3 +/- 17.7 years), including 56 children and adolescents less than 16 years of age. At least one attempt at surgical palliation or correction was made in 93 patients; the remaining 46 patients had no surgical intervention attempts. A total of 225 different tachycardias were found, 93 of which were based on a congenital arrhythmogenic substrate (e.g., an accessory pathway). Acquired substrates (e.g., scars or myocardial fibrosis) gave rise to the remaining 132 tachycardias. Radiofrequency current ablation (183 sessions) successfully treated 121 of 139 patients. Within a follow-up period of 21 months a recurrence of the intrinsically treated tachycardia was seen in 24 patients (10.7%); 13 of the 24 underwent a successful repeat session. There were no significant procedure-related complications. Young and adult patients with congenital heart disease can be safely and successfully treated for tachycardias with the use of radiofrequency current ablation. Because such treatment meets the specific needs of this patient group, early consideration for this therapy is recommended.
患有心脏异常的患者经常遭受心律失常之苦，这些心律失常要么与先天性心脏缺陷相关，要么由疾病进程导致。对于大多数缓慢性心律失常而言，确定治疗开始的恰当时间比最终实施治疗更具挑战性。对于快速性心律失常，治疗的技术层面需要更多关注，因为此类快速性心律失常对生活质量、发病率和死亡率往往有着至关重要的影响，这决定了干预时机。由于抗心律失常药物治疗未能预防心律失常复发，且在这一特定患者群体中可见药物治疗的潜在有害副作用，越来越多的人将介入性电生理学作为一种可能具有决定性且与基质相关的治疗方法。利用过去10年在治疗无相关结构性心脏病的心律失常患者过程中积累的经验，多个团队报告了他们将此类治疗应用于先天性心脏缺陷患者的结果及困难。在本报告中，我们总结了我院对139例患有先天性心脏缺陷的儿童和成人应用经导管射频电流治疗各种类型快速性心律失常的经验，强调了此类治疗目前的局限性，并探讨了未来技术有望带来的潜在益处。患者年龄从5个月至76岁不等（平均25.3±17.7岁），其中包括56例年龄小于16岁的儿童和青少年。93例患者至少接受过一次手术姑息治疗或矫正；其余46例患者未尝试手术干预。共发现225种不同的快速性心律失常，其中93种基于先天性致心律失常基质（如附加通路）。其余132种快速性心律失常由后天性基质（如瘢痕或心肌纤维化）引起。射频电流消融（183次治疗）成功治疗了139例患者中的121例。在21个月的随访期内，24例患者（10.7%）出现了原本治疗的快速性心律失常复发；24例中的13例成功接受了再次治疗。没有与手术相关的严重并发症。患有先天性心脏病的儿童和成人患者可通过射频电流消融安全、成功地治疗快速性心律失常。由于此类治疗满足了该患者群体的特殊需求，建议尽早考虑采用这种治疗方法。
