Ott D A, Cooley D A, Moak J, Friedman R A, Perry J, Garson A
Division of Cardiovascular Surgery, Texas Heart Institute, Luke's Episcopal Hospital, Houston 77225-0345.
J Am Coll Cardiol. 1993 Apr;21(5):1205-10. doi: 10.1016/0735-1097(93)90247-x.
The purpose of this report is to summarize our entire surgical experience in the treatment of tachyarrhythmias in children. We emphasize our application of a newer computerized mapping system for use in both the electrophysiology laboratory and the operating room to localize points of activation of the tachyarrhythmias.
A retrospective review was undertaken to examine the results of operative procedures in 290 children undergoing surgical treatment for tachyarrhythmias from 1977 to the present.
Operative procedures were performed in 290 children and consisted of the following: surgical ablation of accessory pathways of the Kent bundle type (210 children); surgery with cryoablation for atrial ectopic tachycardia (35 children); surgical excision or cryoablation, or both, for ventricular tachycardia (26 children); cryoablation for the permanent form of junctional reciprocating tachycardia (15 children) and atrioventricular (AV) node reentrant tachycardia (4 children).
The surgical cure rate for accessory pathway tachycardia in the era before computerized mapping was 80% (41 patients) in the period from 1977 to 1982 and 95% (86 patients) in the period from 1982 to 1988. This rate improved to 100% (83 patients) after the advent of the computerized mapping technique. These improved results are probably due to a combination of factors, including increasing experience in electrophysiologic mapping and surgery, and cannot be attributed to the computerized mapping system alone. Surgical cure or major improvement in symptoms was documented in 33 (94%) of 35 patients with atrial ectopic tachycardia. Surgical cure was accomplished in 25 (96%) of 26 patients with the complex form of ventricular tachycardia. In 19 patients with the permanent form of junctional reciprocating tachycardia and the more typical AV node reentrant tachycardia, the surgical cure rate was 100%.
In all forms of supraventricular reentrant tachycardia that occur in children, preoperative computerized mapping techniques combined with intraoperative computerized mapping and surgical ablation can eliminate tachycardia at a success rate of close to 100%. Computerized mapping techniques are less accurate in patients with atrial ectopic tachycardia because of multiple foci and a broader surface area to be mapped. This experience demonstrates that excellent results can be achieved in the surgical treatment of tachyarrhythmias in children.
本报告旨在总结我们治疗儿童快速心律失常的全部手术经验。我们着重介绍一种更新的计算机化标测系统在电生理实验室和手术室中的应用，以定位快速心律失常的激动点。
进行了一项回顾性研究，以考察1977年至目前接受快速心律失常手术治疗的290例儿童的手术结果。
对290例儿童实施了手术，包括以下几种：肯特束型附加旁道的手术消融（210例儿童）；冷冻消融治疗房性异位性心动过速的手术（35例儿童）；室性心动过速的手术切除或冷冻消融，或两者结合（26例儿童）；冷冻消融治疗永久性交界性折返性心动过速（15例儿童）和房室结折返性心动过速（4例儿童）。
在计算机化标测时代之前，1977年至1982年期间附加旁道性心动过速的手术治愈率为80%（41例患者），1982年至1988年期间为95%（86例患者）。计算机化标测技术出现后，这一治愈率提高到了100%（83例患者）。这些改善的结果可能是多种因素共同作用的结果，包括电生理标测和手术经验的增加，而不能仅仅归因于计算机化标测系统。35例房性异位性心动过速患者中有33例（94%）记录到手术治愈或症状有显著改善。26例复杂性室性心动过速患者中有25例（96%）实现了手术治愈。19例永久性交界性折返性心动过速和更典型的房室结折返性心动过速患者的手术治愈率为100%。
在儿童发生的所有形式的室上性折返性心动过速中，术前计算机化标测技术与术中计算机化标测及手术消融相结合，可使心动过速消除的成功率接近100%。由于存在多个病灶且需标测的表面积较大，计算机化标测技术在房性异位性心动过速患者中的准确性较低。这一经验表明，儿童快速心律失常的手术治疗可取得优异的效果。
