Butto F, Dunnigan A, Overholt E D, Benditt D G, Benson D W
Am J Cardiol. 1986 Jun 1;57(15):1356-62. doi: 10.1016/0002-9149(86)90218-3.
Transesophageal study was used for diagnosis and treatment of 51 episodes of tachycardia in 13 patients with complete transposition of the great arteries who had undergone atrial baffle procedure. At the time of atrial baffle procedure, patients were 6 to 36 months old (mean 23). Tachycardia (1 to 17 episodes per patient) first occurred 1 to 23 days (4 patients) or 1.8 to 12 years (9 patients) after atrial baffle. Transesophageal study was performed using a bipolar silicone rubber-coated catheter. Tachycardia conversion was accomplished with stimulation bursts using 4 to 10 stimuli 9.9 ms in duration at 20 to 28 mA and an interstimulus interval of 50 to 100 ms less than the atrial cycle length. All tachycardia episodes had regular atrial cycle lengths ranging from 200 to 350 ms. In 12 patients, second-degree atrioventricular (AV) block was observed during tachycardia, suggesting primary atrial tachycardia. However, in 1 patient, occurrence of AV block always resulted in tachycardia termination, suggesting the presence of AV reentrant tachycardia. Transesophageal stimulation converted 48 of 51 tachycardia episodes to sinus/junctional rhythm. Ten tachycardia episodes in 6 patients were transiently converted to atrial fibrillation lasting 3 seconds to 28 minutes before spontaneous conversion to sinus junctional rhythm. Conversion attempts were unsuccessful on 3 occasions. Acceleration of ventricular rate after stimulation necessitated DC cardioversion on 1 occasion. Conversion was not achieved in 2 tachycardia episodes using stimuli less than 10 mA. Transesophageal study is a safe and effective minimally invasive technique for diagnosis and treatment of tachycardia in infants and children who have had atrial baffle for transposition of the great arteries.
经食管研究用于诊断和治疗13例大动脉完全转位且已接受心房内板障手术患者的51次心动过速发作。在进行心房内板障手术时，患者年龄为6至36个月（平均23个月）。心动过速（每位患者1至17次发作）首次发生于心房内板障手术后1至23天（4例患者）或1.8至12年（9例患者）。经食管研究使用双极硅胶涂层导管进行。通过刺激脉冲实现心动过速转复，刺激脉冲采用4至10次刺激，持续时间为9.9毫秒，电流为20至28毫安，刺激间期比心房周期长度短50至100毫秒。所有心动过速发作的心房周期长度均规则，范围为200至350毫秒。在12例患者中，心动过速发作时观察到二度房室传导阻滞，提示原发性房性心动过速。然而，在1例患者中，房室传导阻滞的出现总是导致心动过速终止，提示存在房室折返性心动过速。经食管刺激使51次心动过速发作中的48次转复为窦性/交界性心律。6例患者的10次心动过速发作在自发转复为窦性交界性心律之前短暂转复为心房颤动，持续3秒至28分钟。有3次转复尝试未成功。1次刺激后心室率加速需要直流电复律。使用小于10毫安的刺激未能使2次心动过速发作转复。经食管研究是一种安全有效的微创技术，用于诊断和治疗已接受大动脉转位心房内板障手术的婴幼儿心动过速。
