Department for Pediatric Cardiology and Intensive Care Medicine, Georg-August-University, Göttingen, Germany.
Heart Rhythm. 2010 Jun;7(6):731-9. doi: 10.1016/j.hrthm.2010.02.031. Epub 2010 Feb 26.
Idiopathic ventricular tachycardia (VT) in children with a structurally normal heart can cause significant morbidity, and although rare, mortality. Conventional activation and pace mapping may be limited by nonsustained tachycardia or unstable hemodynamics.
The aim of this study was to assess feasibility of catheter ablation of idiopathic VT in the pediatric population guided by noncontact mapping.
Twenty consecutive pediatric patients with idiopathic VT underwent electrophysiologic study with the intention to use the noncontact mapping system EnSite 3000 (EnSite Array, St. Jude Medical Inc., Minneapolis, Minnesota). The multielectrode balloon array was introduced into the left or right ventricle, respectively, and tachycardia was analyzed using color-coded isopotential maps as well as reconstructed unipolar electrograms on the virtual geometry. The region of origin was identified in all of them, and the site of earliest activation with a QS pattern of the unipolar electrograms was guided for sites of ablation.
Idiopathic VT originated from the right ventricular outflow tract in 6 patients, from the left ventricle in 8, and from the aortic sinus cusp in 6 in this cohort with a median age of 14.4 (range: 4.8 to 20.9) years. Ablation was attempted in 18 of 20 children, and was acutely successful in 17 of these 18 (94%). During a mean follow-up of 2.3 +/- 1.7 years, VT recurred in 3, 2 of them have been treated with a second procedure, resulting in an overall intermediate-term success in 16 of 18 (89%) children with idiopathic VT.
Noncontact mapping can safely and effectively be used to map and guide catheter ablation of the tachycardia substrate of idiopathic VT in pediatric patients.
结构正常的儿童特发性室性心动过速（VT）可导致显著的发病率，尽管罕见，但也可导致死亡率。常规激动和起搏标测可能会受到非持续心动过速或不稳定血液动力学的限制。
本研究旨在评估非接触式标测指导下儿童特发性 VT 导管消融的可行性。
20 例连续的特发性 VT 患儿接受电生理检查，意图使用非接触式标测系统 EnSite 3000（EnSite Array，St. Jude Medical Inc.，明尼苏达州明尼阿波利斯）。多电极球囊分别引入左心室或右心室，使用彩色等电位图和虚拟几何上重建的单极电图分析心动过速。在所有患者中确定起源部位，并引导单极电图呈 QS 模式的最早激活部位进行消融部位。
在本队列中，6 例起源于右心室流出道，8 例起源于左心室，6 例起源于主动脉窦嵴，中位年龄为 14.4（范围：4.8 至 20.9）岁。20 例患儿中有 18 例尝试消融，其中 17 例即刻成功（94%）。在平均 2.3+1.7 年的随访中，3 例复发，其中 2 例再次行介入治疗，18 例患儿中有 16 例（89%）特发性 VT 获得了中期成功。
非接触式标测可安全有效地用于特发性 VT 患儿的心动过速基质的标测和指导导管消融。
