解剖结构与儿童流出道室性心律失常射频消融相关性分析

发布时间：2018-06-04 06:51

本文选题：儿童 + 射频导管消融　；参考：《清华大学》2016年博士论文

【摘要】：流出道室性心律失常是儿童特发性室性心律失常的常见形式,射频导管消融术是其重要的治疗手段。本文旨在探讨以解剖为基础的较大样本量儿童流出道室性心律失常射频消融术的效果、策略及术前心电图定位的可靠性,以期为提高消融成功率、减少手术时间和X线曝光量提供依据。本研究分析了因流出道室性心律失常在清华大学第一附属医院接受射频导管消融术的94例儿童电生理及心电图资料。结果显示:(1)94例流出道室性心律失常儿童平均发病年龄8.36±4.07(2~16)岁;频发室性期前收缩占室性心律失常的68.1%(64/94);流出道室性心律失常主要起源于右室流出道(73.4%,69/94)。(2)94例流出道起源室性心律失常射频消融即时成功率为92.4%(85/92),放弃消融2例,随访复发率8.2%(7/85),手术并发症发生率2.1%(2/94)。采用单侧标测消融的88例,其中右室流出道单侧标测消融的占76.1%(67/88),消融成功率89.6%(60/67),随访复发率6.7%(4/60)。左室流出道单侧标测消融的占23.9%(21/88),予以消融19例,均获消融成功(100%),放弃消融2例,随访复发率为15.8%(3/19)。流出道双侧对照标测消融的6例,均获成功,随访无复发。(3)儿童流出道室性心律失常心电图特征与成人类似。(4)目前通用的四种心电图定位算法对儿童左室流出道起源室性心律失常定位准确率偏低:阳性预测率为47.4~71.4%,敏感性为36.0%-68.0%,特异性为85.5~91.3%。(5)本组资料中将左室流出道进一步细化分组为左冠窦起源和右冠窦起源组,显示心电图对左冠窦起源的阳性预测值、敏感性和特异性均远高于右冠窦起源的室性心律失常。本研究显示儿童流出道室性心律失常以右室流出道起源最多见;射频导管消融可安全有效的用于治疗有临床症状或药物治疗效果不佳及药物不能耐受的儿童流出道室性心律失常。基于流出道毗邻结构特点,细化心电图定位算法分组,可筛选出定位准确的左冠窦起源的室性心律失常。对于心电图算法强烈提示左冠窦起源的室性心律失常者,可直接经左冠窦标测消融,以减少手术操作时间、对血管的损伤以及放射线曝光时间;对于心电图不易鉴别的右室流出道间隔或右冠窦的室性心律失常,心电图特征仅作为参考,部分病例术中需要实施双侧标测或消融,可以增加消融成功率,降低复发率。本研究通过较大样本儿童流出道室性心律失常射频导管消融的数据分析,为改善儿童该类手术疗效提供了可借鉴的经验。
[Abstract]:Outflow tract ventricular arrhythmia is a common form of idiopathic ventricular arrhythmias in children. Radiofrequency catheter ablation is an important treatment. The purpose of this study was to investigate the effect, strategy and reliability of electrocardiographic localization of outflow tract ventricular arrhythmias in children based on anatomy, in order to improve the success rate of ablation. Reduce the operation time and X-ray exposure to provide the basis. The electrophysiological and electrocardiographic data of 94 children undergoing radiofrequency catheter ablation due to outflow tract ventricular arrhythmia in the first affiliated Hospital of Tsinghua University were analyzed. The results showed that the average onset age of 94 children with outflow tract ventricular arrhythmia was 8.36 卤4.07 ~ 216 years old. Frequent premature ventricular contraction accounted for 68.1% of ventricular arrhythmias, and outflow tract ventricular arrhythmias mainly originated from right ventricular outflow tract 73.469 / 94. The immediate success rate of radiofrequency ablation of outflow tract originated ventricular arrhythmias was 92.485 / 92and 2 patients gave up ablation. The recurrence rate was 8. 2% and the operative complication rate was 2. 1% / 94%. In 88 cases of unilateral mapping ablation, 76. 1% of them were ablated by unilateral mapping of right ventricular outflow tract (RVOT). The successful rate of ablation was 89.6% 60 / 67%, and the recurrence rate was 6. 7% / 60%. The left ventricular outflow tract with unilateral ablation accounted for 23.9% of 21 / 88 cases, 19 cases were ablated successfully, and 2 cases were abandoned. The recurrence rate was 15.8%. The ablation of the outflow tract was successfully performed in 6 patients with bilateral control. Follow up. 3) electrocardiogram characteristics of outflow tract ventricular arrhythmias in children are similar to those in adults.) the accuracy of four common electrocardiographic localization algorithms for the location of ventricular arrhythmias originating from left ventricular outflow tract in children is low: positive prediction The left ventricular outflow tract was further subdivided into left coronary sinus origin group and right coronary sinus origin group. The positive predictive value, sensitivity and specificity of ECG for the origin of left coronary sinus were significantly higher than that of ventricular arrhythmia derived from right coronary sinus. This study showed that the origin of right ventricular outflow tract was the most common in children with outflow tract ventricular arrhythmia. Radiofrequency catheter ablation is a safe and effective method for the treatment of outflow tract ventricular arrhythmias in children with clinical symptoms or poor drug efficacy and drug intolerance. Based on the characteristics of adjacent structure of outflow tract, the electrocardiographic localization algorithm can be divided into two groups, and the accurate location of ventricular arrhythmias originating from left coronary sinus can be selected. For patients with ventricular arrhythmias originating from left coronary sinus, electrocardiogram (ECG) algorithm strongly suggests that ablation can be performed directly through left coronary sinus mapping in order to reduce operative time, vascular injury and radiation exposure time. For ventricular arrhythmias of right ventricular outflow tract septum or right coronary sinus which are difficult to distinguish by electrocardiogram, the characteristics of ECG are only for reference. In some cases, bilateral mapping or ablation is needed during operation, which can increase the success rate of ablation and reduce the recurrence rate. In this study, the data of radiofrequency catheter ablation of outflow tract ventricular arrhythmias were analyzed in a large sample of children.
【学位授予单位】：清华大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R725.7

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