儿童快速性心律失常电生理特征及射频消融疗效分析

发布时间：2018-03-15 00:17

本文选题：儿童　切入点：心律失常　出处：《上海交通大学》2015年博士论文　论文类型：学位论文

【摘要】：【背景】快速性心律失常如阵发性室上性心动过速、室性心动过速、室性早搏等在儿童并不少见,传统的药物治疗多不能有效根治,射频消融术因其独特的根治效果在成人心血管领域已经广泛应用,但在儿科还缺乏较大样本的系统研究。【目的】通过较大样本量研究儿童室上性心动过速(SVT)及室性心律失常(VAs)的电生理特征及射频消融疗效及SVT的电生理特征与儿童室上性心动过速射频消融疗效相关性,为制定适合我国国情的儿童快速性心律失常射频消融专家共识提供一定的循征医学依据。【方法】收集自2002年11月至2014年10月在上海儿童医学中心心内科行电生理检查及射频消融术的连续543例快速性心律失常患儿资料,包括457例SVT及86例VAs,回顾性分析其临床特点、电生理检查结果、射频消融疗效、并发症及随访情况,并对2013年1月至2014年10月期间的153例阵发性室上性心动过速(PSVT)患儿的电生理参数与射频消融疗效的相关性进行分析。【结果】543例患儿中,房室结折返性心动过速(AVNRT)患儿163例,房室折返性心动过速(AVRT)患儿294例,室性早搏(PVC)患儿49例,室性心动过速(VT)患儿37例。SVT射频消融成功率高于VAs(93.7%vs.80.2%),其中左侧旁道即刻成功率最高为99.3%,其次为AVNRT 98.2%,室性早搏成功率最低为79.6%。SVT总体复发率为9.1%,VAs复发率为15.9%。AVNRT射频消融术后是否复发与术后心房程序刺激是否发生AH跳跃合并心房回波有关(p=0.001),而AVRT射频消融术后是否复发则与术后心室刺激室房分离时的刺激周长有关(p=0.043)。SVT手术并发症发生率为4.6%,无严重并发症发生,VAs手术未发现手术相关并发症。【结论】只要操作规范、适应征把握适当,射频消融术可安全、有效地治疗儿童快速性心律失常,掌握儿童室上性心动过速的电生理特征可提高手术成功率,并减少复发的可能。
[Abstract]:[background] rapid arrhythmia such as paroxysmal supraventricular tachycardia, ventricular tachycardia, ventricular premature beats are not uncommon in children, the traditional drug treatment can effectively cure, radiofrequency ablation due to its unique curative effect in adult cardiovascular field has been widely used, but also the lack of systematic research on large sample in the Department of Pediatrics. [Objective] through large data of children with paroxysmal supraventricular tachycardia (SVT) and ventricular arrhythmia (VAs) electrophysiological characteristics and radiofrequency ablation of SVT and electrophysiological characteristics of children with supraventricular tachycardia radiofrequency ablation for ablation of correlation, the expert consensus with syndrome according to the children's medical tachyarrhythmia frequency for China's national conditions. [method] collected from November 2002 to October 2014 in the Department of Cardiology of Shanghai Children's Medical Center underwent electrophysiological examination and radio frequency. The financial operation of 543 consecutive cases of tachyarrhythmia in children, including 457 cases of SVT and 86 cases of VAs were retrospectively analyzed the clinical features, electrophysiological findings, radiofrequency ablation, complications and follow-up, and 153 cases of paroxysmal ventricular during the period from January 2013 to October 2014 on tachycardia (PSVT) correlation power the physiological parameters and efficacy of radiofrequency ablation in children were analyzed. [results] 543 cases of atrioventricular nodal reentrant tachycardia (AVNRT) of 163 patients with atrioventricular reentrant tachycardia (AVRT) in 294 children with ventricular premature beat (PVC) of 49 patients with ventricular tachycardia (VT) in 37 children with.SVT ablation success rate is higher than that of VAs (93.7%vs.80.2%), the success rate of immediate left accessory pathway up to 99.3%, followed by AVNRT 98.2%, the success rate of ventricular premature beat minimum 79.6%.SVT overall recurrence rate was 9.1%, the recurrence rate of VAs was 15.9%.AVNRT after radiofrequency ablation is Recurrence and postoperative atrial programmed stimulation is associated with atrial echo AH jump (p=0.001), and the AVRT recurrence after radiofrequency ablation is associated with postoperative ventricular atrial ventricular stimulation during the separation of stimulus perimeter (p=0.043) complications of.SVT incidence rate was 4.6%, no serious complications, no complications related to surgery VAs surgery. [Conclusion] as long as the operating norms, grasp the indications for appropriate radiofrequency ablation is safe, effective treatment of tachyarrhythmia in children, children's mastery of supraventricular tachycardia electrophysiological characteristics can improve the operation success rate, and reduce the possibility of recurrence.

【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R725.4

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