Liu Jing, Cao Xiaoxiao, Li Changjian, Feng Xiaoyuan, Sun Dongming, Zhang Yong
Department of Cardiology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiac Ultrasound, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Cardiovasc Med. 2022 Oct 18;9:990325. doi: 10.3389/fcvm.2022.990325. eCollection 2022.
The aim of this study was to investigate the efficacy of radiofrequency catheter ablation (RFCA) combined with atrial appendage (AA) resection to treat atrial tachycardia (AT) originating from the AA in children.
Using the Ensite three-dimensional electroanatomic mapping system, three children with AT originating from the AA were diagnosed. Clinical features and electrocardiographic (ECG) manifestations were analyzed. Ablations were performed using a cold saline-infused catheter at appendages targeting loci of AT origin under the guidance of the Ensite system. Atrial appendage resection was performed in combination with cardiac surgery, and the curative effect was evaluated.
The ages of the three patients were 3.5, 5.75, and 12.9 years. Two cases originated from the right atrial appendage (RAA) and one originated from the left atrial appendage (LAA). The ECG characteristics of AT from the RAA were as follows: (1) negative P waves in lead V1; (2) positive P waves in leads II, III, and aVF; (3) positive P wave in lead I with varying shapes in lead aVL; and (4) prolonged PR interval with no QRS wave after some P waves. The ECG of the LAA was characterized by (1) positive P waves in lead V1 with a bimodal pattern; (2) positive P waves in leads II, III, and aVF; and (3) negative P waves in leads I and aVL. Preoperative echocardiography showed cardiac enlargement and a decreased left ventricular ejection fraction (LVEF) in all three cases. One case was cured after RFCA, and the remaining two cases required AA resection after RFCA. No recurrence was detected at 1-18 months of follow-up, and the left ventricular end-diastolic diameter and LVEF returned to normal.
Atrial tachycardia originating from the AA in children showed a characteristic P-wave presentation on ECG, and sustained episodes of AT resulted in tachycardia-induced cardiomyopathy. Children who are not successfully controlled by RFCA or who have a recurrence after RFCA could benefit from AA resection.
本研究旨在探讨射频导管消融（RFCA）联合心房附件（AA）切除术治疗儿童源自心房附件的房性心动过速（AT）的疗效。
使用Ensite三维电解剖标测系统，诊断出3例源自心房附件的房性心动过速患儿。分析其临床特征和心电图（ECG）表现。在Ensite系统引导下，使用冷盐水灌注导管对心房附件的房性心动过速起源部位进行消融。联合心脏手术进行心房附件切除术，并评估疗效。
3例患者年龄分别为3.5岁、5.75岁和12.9岁。2例起源于右心房附件（RAA），1例起源于左心房附件（LAA）。源自RAA的房性心动过速的心电图特征如下：（1）V1导联P波倒置；（2）II、III和aVF导联P波直立；（3）I导联P波直立，aVL导联P波形态各异；（4）PR间期延长，部分P波后无QRS波。LAA的心电图特征为：（1）V1导联P波直立，呈双峰形态；（2）II、III和aVF导联P波直立；（3）I和aVL导联P波倒置。术前超声心动图显示所有3例均有心脏扩大和左心室射血分数（LVEF）降低。1例经RFCA治愈，其余2例在RFCA后需要进行AA切除术。随访1 - 18个月未发现复发，左心室舒张末期直径和LVEF恢复正常。
儿童源自心房附件的房性心动过速在心电图上表现出特征性的P波形态，持续性房性心动过速发作导致心动过速性心肌病。未通过RFCA成功控制或RFCA后复发的儿童可能从AA切除术中获益。
