Zeng Shao-ying, Shi Ji-jun, Ye Ju-heng, Zhang Zhi-wei, Li Yu-fen
Department of Pediatrics, Guangdong Cardiovascular Disease Institute, Guangzhou 510080, China.
Zhonghua Er Ke Za Zhi. 2009 Sep;47(9):705-9.
To explore safety, indications and advantages of mapping and ablation of arrhythmia in children guided by Carto and Ensite system.
Guided by Carto system, radiofrequency catheter ablation (RFCA) was performed on 8 pediatric patients with tachycardia whose mean age was (6.2 + or - 1.7) years, mean weight was (18.0 + or - 2.0) kg. Guided by Ensite system, RFCA was performed on 10 pediatric patients with arrhythmia, 8 of them were ablated guided by Ensite Array system: 6 cases with premature ventricular contractions (PVCs), 2 cases with right atrial tachycardia, their mean age was (11.3 + or - 1.2) years, and mean weight (40.0 + or - 5.0) kg. The other two cases with W-P-W syndrome were ablated guided by Ensite Navx system.
Guided by Carto system, 8 cases were successfully mapped and ablated: 6 cases had incision atrial tachycardia, 1 case had left atrial tachycardia and 1 case had right atrial tachycardia. In 1 case with incision atrial tachycardia the condition recurred after 3 months, and was ablated again successfully. Guided by Ensite Array system, 6 cases with PVCs (in 2 originating from the right ventricular inflow tract and in 4 originating from the right ventricular outflow tract) and 2 cases with right atrial tachycardia were successfully mapped and ablated, PVCs of the first 6 cases were reduced from (32 333 + or - 4509) 24 h to (0-4)/24 h after ablation. In 1 case with automatic atrial tachycardia, mapping could not be done by Ensite Array system, because P wave could not be identified from T wave. Single bolus of adenosine 20 mg was given within 30 s to let ventricles stop for 2 s (cardio-ventricular pacing standby) until T wave vanished, mapping and ablation were operated again successfully, but another atrial tachycardia occurred 1 day later. Guided by Ensite Navx system, 2 cases with W-P-W syndrome were successfully ablated, operation under X-rays lasted for 8 and 10 min. In none of the 9 patients the disease recurred after follow-up for 6 months.
Carto system is suitable for mapping and ablation in pediatric patients with continuous tachycardia, especially with incision atrial tachycardia; Ensite Array system fits children older than 10 years with right heart discontinuous arrhythmia; and Ensite NavX system can set up model and display endocardial anatomic structure quickly. Compared with two-dimensional mapping system, the three-dimensional mapping system (Carto and Ensite) can display the origin of arrhythmia and activation sequence clearly, decrease difficulty of operation efficiently and diminish operation time under X-ray.
探讨Carto系统和Ensite系统指导下儿童心律失常标测与消融的安全性、适应证及优势。
在Carto系统指导下，对8例平均年龄为（6.2±1.7）岁、平均体重为（18.0±2.0）kg的小儿心动过速患者行射频导管消融术（RFCA）。在Ensite系统指导下，对10例小儿心律失常患者行RFCA，其中8例在Ensite Array系统指导下进行消融：6例室性早搏（PVC）、2例右房性心动过速，平均年龄为（11.3±1.2）岁，平均体重（40.0±5.0）kg。另外2例预激综合征患者在Ensite Navx系统指导下进行消融。
在Carto系统指导下，8例成功标测并消融：6例为切口房性心动过速，1例为左房性心动过速，1例为右房性心动过速。1例切口房性心动过速患者术后3个月复发，再次成功消融。在Ensite Array系统指导下，6例PVC（2例起源于右心室流入道，4例起源于右心室流出道）及2例右房性心动过速成功标测并消融，前6例PVC消融后24小时内从（32333±4509）次减少至（0 - 4）次/24小时。1例自动房性心动过速患者，Ensite Array系统无法标测，因T波中无法识别P波。30秒内单次静脉推注腺苷20mg使心室停搏2秒（心室起搏备用）直至T波消失，再次成功进行标测与消融，但1天后又出现房性心动过速。在Ensite Navx系统指导下，2例预激综合征患者成功消融，X线下手术时间分别为8分钟和10分钟。9例患者随访6个月均无复发。
Carto系统适用于小儿持续性心动过速尤其是切口房性心动过速的标测与消融；Ensite Array系统适用于10岁以上小儿右心非持续性心律失常；Ensite NavX系统能快速建立模型并显示心内膜解剖结构。与二维标测系统相比，三维标测系统（Carto和Ensite）能清晰显示心律失常起源及激动顺序，有效降低手术难度，减少X线下手术时间。
