预激综合征患儿的电生理特征及射频导管消融术

Electrophysiologic characteristics and radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome.

作者信息

Lee Pi-Chang, Hwang Betau, Chen Yi-Jen, Tai Ching-Tai, Chen Shih-Ann, Chiang Chern-En

机构信息

Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan.

出版信息

Pacing Clin Electrophysiol. 2006 May;29(5):490-5. doi: 10.1111/j.1540-8159.2006.00381.x.

DOI:10.1111/j.1540-8159.2006.00381.x

PMID:16689844

Abstract

BACKGROUND

The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome.

METHODS

From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome.

RESULTS

The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P=0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P<0.001). Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients.

CONCLUSION

This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.

摘要

背景

儿童心律失常大多为室上性心动过速，主要与旁路（AP）介导的折返机制有关。成人预激综合征（WPW）的研究众多，但儿童相关信息有限。本研究旨在评估儿童WPW综合征的特定电生理特征及射频（RF）导管消融的结果。

方法

1989年12月至2005年8月，纳入在本机构接受消融治疗的142例儿童和1219例房室折返性心动过速（AVRT）成人患者。我们比较了儿童和成人WPW综合征患者的临床和电生理特征。

结果

儿童间歇性WPW综合征的发生率更高（7%对3%，P = 0.025）。儿童诱发心动过速所需的快速心房起搏发生率更高（67%对53%，P = 0.02）。然而，心房颤动（AF）在成年患者中更常见（28%对16%，P = 0.003）。儿科患者多径路发生率更高（5%对1%，P < 0.001）。儿科患者症状的发作和持续时间明显更短。显性WPW综合征儿童的前传1:1 AP传导起搏周期长度（CL）和前传AP有效不应期（ERP）远短于成人。此外，儿童的逆传1:1 AP传导起搏CL和逆传AP ERP也短于成人。儿科患者的前传1:1房室（AV）结传导起搏CL、AV结ERP和心动过速的CL均较短。