Jiang Diandong, Lv Jianli, Han Bo, Yang Xiaofei, Zhao Lijian, Yi Yingchun, Long Deyong, Sang Caihua
Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Front Pediatr. 2022 Feb 9;10:740230. doi: 10.3389/fped.2022.740230. eCollection 2022.
To investigate the electrocardiographic (ECG) characteristics and catheter ablation of ventricular arrhythmias (VAs) originating from the moderator band (MB) in children.
A total of six children who had VAs originating from the MB-as confirmed by electrophysiological study-and who underwent catheter ablation between January 2016 and December 2020 were retrospectively reviewed. During the procedure, a three-dimensional electroanatomic mapping system was used to facilitate three-dimensional anatomical reconstruction, mapping and ablation. Patients' clinical characteristics, ECG features and procedural data were collected and analyzed.
The mean age was 8.4 ± 2.6 years (range: 5.3-11 years) and mean weight was 27.7 ± 11.4 kg (range: 17-47 kg). Four patients presented with frequent premature ventricular contraction (PVC), one patient presented with frequent PVC and non-sustained ventricular tachycardia, and one patient presented with sustained monomorphic ventricular tachycardia. The QRS duration averaged 126.3 ± 4.6 ms. In all patients, the VAs had left bundle branch block QRS with left superior frontal plane axes, rapid downstrokes of the QRS in the precordial leads, and late precordial transitions (>V). During the same period, 10 cases of VAs originated from the posterior-lateral wall of the tricuspid annulus, with a mean QRS duration of 152.8 ± 6.4 ms. Compared to that, VAs of MB origin have narrower QRS widths, downstroke slopes in the inferior lead, sharper downstroke slopes in the precordial lead, and smaller R-wave amplitudes in the V lead. All patients experienced immediate ablation success with activations earlier than QRS by 26.0 ± 3.5 ms, and no procedural complications occurring. Only one case had recurrent PVC during a follow-up period ranging from 6 to 36 months.
MB VAs in children have distinctive ECG morphology and electrophysiological characteristics. Catheter ablation using a three-dimensional electroanatomic mapping system is safe and effective in these patients.
研究儿童起源于节制索（MB）的室性心律失常（VA）的心电图特征及导管消融情况。
回顾性分析2016年1月至2020年12月期间6例经电生理检查证实起源于MB且接受导管消融的儿童患者。手术过程中，使用三维电解剖标测系统辅助三维解剖重建、标测和消融。收集并分析患者的临床特征、心电图特征及手术数据。
平均年龄为8.4±2.6岁（范围：5.3 - 11岁），平均体重为27.7±11.4千克（范围：17 - 47千克）。4例患者表现为频发室性早搏（PVC），1例患者表现为频发PVC和非持续性室性心动过速，1例患者表现为持续性单形性室性心动过速。QRS时限平均为126.3±4.6毫秒。所有患者的室性心律失常均表现为左束支阻滞QRS波，额面电轴左上，胸前导联QRS波下降支快速，胸前导联过渡延迟（>V）。同期，10例起源于三尖瓣环后外侧壁的室性心律失常，平均QRS时限为152.8±6.4毫秒。相比之下，起源于MB的室性心律失常QRS波宽度更窄，下壁导联下降支斜率、胸前导联下降支斜率更陡，V导联R波振幅更小。所有患者均即刻消融成功，激动时间早于QRS波26.0±3.5毫秒，且无手术并发症发生。随访6至36个月期间，仅1例患者出现PVC复发。
儿童起源于MB的室性心律失常具有独特的心电图形态和电生理特征。使用三维电解剖标测系统进行导管消融对这些患者安全有效。
