年轻患者的多条旁路：结构性心脏病的影响。
Multiple accessory pathways in the young: the impact of structural heart disease.
机构信息
Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
出版信息
Am Heart J. 2013 Jan;165(1):87-92. doi: 10.1016/j.ahj.2012.10.025. Epub 2012 Nov 20.
BACKGROUND
The presence of multiple accessory pathways (MultAP) is described in structural heart disease (SHD) such as Ebstein's anomaly and cardiomyopathies. Structural defects can impact the tolerability of tachyarrhythmia and can complicate both medical management and ablation. In a large cohort of pediatric patients with and without SHD undergoing invasive electrophysiology study, we examined the prevalence of MultAP and the effect of both MultAP and SHD on ablation outcomes.
METHODS
Accessory pathway number and location, presence of SHD, ablation success, and recurrence were analyzed in consecutive patients from our center over a 16-year period.
RESULTS
In 1088 patients, 1228 pathways (36% retrograde only) were mapped to the right side (TV) in 18%, septum (S) in 39%, and left side (MV) in 43%. MultAP were present in 111 pts (10%), involving 250 distinct pathways. SHD tripled the risk of MultAP (26% SHD vs 8% no SHD, P < .001). Multivariable adjusted risk factors for MultAP included Ebstein's (OR 8.7[4.4-17.5], P < .001) and cardiomyopathy (OR 13.3[5.1-34.5], P < .001). Of 1306 ablation attempts, 94% were acutely successful with an 8% recurrence rate. Ablation success was affected by SHD (85% vs 95% for no SHD, P < .01) but not by MultAP (91% vs 94% for single, P = .24). Recurrence rate was higher for SHD (17% SHD vs 8% no SHD, P < .05) and MultAP (19% MultAP vs 8% single, P < .001).
CONCLUSIONS
MultAP are found in 10% of pediatric patients, and are more common in SHD compared to those with normal hearts. Both the presence of MultAP and SHD negatively influence ablation outcomes.
背景
在结构性心脏病（SHD）中，如埃布斯坦畸形和心肌病，存在多个附加旁路（MultAP）。结构性缺陷会影响心动过速的耐受性，并使药物治疗和消融复杂化。在一项对患有和不患有 SHD 的儿科患者进行侵袭性电生理研究的大队列中，我们检查了 MultAP 的患病率以及 MultAP 和 SHD 对消融结果的影响。
方法
在过去 16 年中，对我们中心连续患者的旁路数量和位置、SHD 的存在、消融成功率和复发率进行了分析。
结果
在 1088 例患者中，1228 条旁路（36%为逆行）被定位到右侧（TV）的 18%、间隔（S）的 39%和左侧（MV）的 43%。111 例（10%）患者存在 MultAP，涉及 250 条不同的旁路。SHD 使 MultAP 的风险增加了两倍（26%SHD 与 8%无 SHD，P<.001）。MultAP 的多变量调整危险因素包括埃布斯坦畸形（OR 8.7[4.4-17.5]，P<.001）和心肌病（OR 13.3[5.1-34.5]，P<.001）。1306 次消融尝试中，94%为急性成功，复发率为 8%。SHD 影响消融成功率（85%vs 95%无 SHD，P<.01），但 MultAP 无影响（单旁路 91%vs 94%，P=.24）。SHD 的复发率较高（17%SHD 与 8%无 SHD，P<.05）和 MultAP（19%MultAP 与 8%单旁路，P<.001）。
结论
MultAP 在 10%的儿科患者中发现，与正常心脏患者相比，在 SHD 中更为常见。MultAP 和 SHD 的存在均对消融结果产生负面影响。
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