电生理特征和结构性正常心脏儿童心动过速性心肌病的导管消融结果。
Electrophysiologic characteristics and catheter ablation results of tachycardia-induced cardiomyopathy in children with structurally normal heart.
机构信息
Department of Pediatric Cardiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital; İstanbul-Turkey.
出版信息
Anatol J Cardiol. 2020 Dec;24(6):370-376. doi: 10.14744/AnatolJCardiol.2020.99165.
OBJECTIVE
The aim of this study is to present electrophysiologic characteristics and catheter ablation results of tachycardia-induced cardiomyopathy (TIC) in children with structurally normal heart.
METHODS
We performed a single-center retrospective review of all pediatric patients with TIC, who underwent an electrophysiology study and ablation procedure in our clinic between November 2013 and January 2019.
RESULTS
A total of 26 patients, 24 patients with single tachyarrhythmia substrates and two patients each with two tachyarrhythmia substrates, resulting with a total of 28 tachyarrhythmia substrates, underwent ablation for TIC. The median age was 60 months (2-214 months). Final diagnoses were supraventricular tachycardia (SVT) in 24 patients and ventricular tachycardia (VT) in two patients. The most common SVT mechanisms were focal atrial tachycardia (31%), atrioventricular reentrant tachycardia (27%), and permanent junctional reciprocating tachycardia (15%). Radiofrequency ablation (RFA) was performed in 15 tachyarrhythmia substrates, and cryoablation was performed in 13 tachyarrhythmia substrates, as the initial ablation method. Acute success in ablation was achieved in 24 out of 26 patients (92%). Tachycardia recurrence was observed in two patients (8%) on follow-up, who were treated successfully with repeated RFA later on. Overall success rates were 92% (24 out of 26) in patients and 93% (26 out of 28) in substrates. On echocardiography controls, the median left ventricular recovery time was 3 months (1-24 months), and median reversible remodeling time was 6 months (3-36 months).
CONCLUSION
TIC should be kept in mind during differential diagnosis of dilated cardiomyopathy. Pediatric TIC patients can be treated successfully and safely with RFA or cryoablation. With an early diagnosis of TIC and quick restoration of the normal sinus rythm, left ventricular recovery, and remodeling may be facilitated.
目的
本研究旨在介绍结构正常心脏儿童心动过速性心肌病（TIC）的电生理特征和导管消融结果。
方法
我们对 2013 年 11 月至 2019 年 1 月期间在我院行电生理研究和消融术的所有 TIC 儿科患者进行了单中心回顾性研究。
结果
共有 26 例患者，其中 24 例为单一心动过速底物，2 例各有两种心动过速底物，共 28 种心动过速底物行消融术治疗 TIC。中位年龄为 60 个月（2-214 个月）。最终诊断为 24 例患者为室上性心动过速（SVT），2 例为室性心动过速（VT）。最常见的 SVT 机制为局灶性房性心动过速（31%）、房室折返性心动过速（27%）和永久性结间折返性心动过速（15%）。15 种心动过速底物行射频消融（RFA），13 种心动过速底物行冷冻消融，作为初始消融方法。26 例患者中，24 例（92%）在消融后即刻获得成功。2 例（8%）在随访中出现心动过速复发，后经重复 RFA 成功治疗。患者总体成功率为 92%（24 例），心动过速底物总体成功率为 93%（26 例）。超声心动图检查显示，左心室恢复时间的中位数为 3 个月（1-24 个月），可恢复性重构时间的中位数为 6 个月（3-36 个月）。
结论
在扩张型心肌病的鉴别诊断中应考虑 TIC。儿科 TIC 患者可通过 RFA 或冷冻消融成功且安全地治疗。早期诊断 TIC 并快速恢复正常窦性节律，可能有助于左心室恢复和重构。
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