儿童快速型心律失常射频消融治疗复发原因临床分析

发布时间：2018-08-22 19:33

【摘要】：目的通过对射频消融治疗儿童阵发性心动过速复发病例及复发病例再次消融回顾性研究,探讨经导管治疗儿童阵发性心动过速复发原因,为儿童射频消融治疗提供可借鉴的经验。方法回顾性研究在我中心2004年10月-2016年9月于我中心射频消融治疗阵发性心动过速的患者,总共142例,其中室上性心动过速132例,室性心律失常10例。术后复发15例,术中失败3例。复发病例中其中7例行二次消融。7例均为男性患儿;年龄为5岁~12岁7个月,平均8.7±3岁;体重20kg~44kg之间,平均30±8.4kg。结果142例病例急性期消融成功率为97.9%,术后复发15例,术中失败3例,复发率为10.6%。18例中,男12例,女6例,年龄5岁~14岁6月,平均年龄9.46±3.20岁。房室结折返者7例,复发时间在10天~1.5年,左侧旁道者2例,右侧旁道者6例,室性心动过速者3例。18例病例中以心悸为主要表现有12例,心悸伴面色苍白及大汗淋漓者7例,心悸伴恶心、呕吐等胃肠道症状者2例。1例以晕厥为主要表现;5例表现为心前区不适,心前区闷胀感,乏力等表现。因上呼吸道感染诱发心律失常者占6例,2例因剧烈活动后诱发心律失常,1例因情绪紧张诱发心律失常。射频消融术后复发者中有5例是因为再次上呼吸道感染诱发,1例是因为剧烈活动后再次诱发心律失常。7例复发病例再次消融即刻成功率为100%,随访12个月~59个月,平均30±17个月,均未再次复发,成功率为100%。首次消融旁道路径为房室结折返者4例,其中1例再次消融标测路径为左后分支来源的特发性室性心动过速;左侧旁路途径者1例;右侧旁道2例,1例伴有频发房型早搏及左室增大,1例首次术后仍有预激综合征表现,1年后再次手术术后出现三尖瓣中度反流,术后出现QT高值,动态心电图心率变异性差。结论消融不彻底及遗漏潜在的残余路径是消融失败主要原因。
[Abstract]:Objective to investigate the causes of recurrent paroxysmal tachycardia in children treated by radiofrequency catheter ablation (RFCA). To provide reference experience for radiofrequency ablation in children. Methods A retrospective study was conducted in 142 patients with paroxysmal tachycardia treated with radiofrequency ablation in our center from October 2004 to September 2016, including 132 cases of supraventricular tachycardia and 10 cases of ventricular arrhythmia. Postoperative recurrence occurred in 15 cases and failure in 3 cases. Among them, 7 cases were treated with secondary ablation, 7 cases were male, the age was 5 years old, 12 years old, 7 months old, the average age was 8.7 卤3 years, and the average weight of 20kg~44kg was 30 卤8.4 kg. Results the successful rate of ablation in the acute phase of 142 cases was 97.9, recurrence in 15 cases, failure in operation in 3 cases, recurrence rate of 10.6.18 cases, male 12 cases, female 6 cases, age from 5 years to 14 months old, mean age 9.46 卤3.20 years old. There were 7 cases of atrioventricular nodal reentry, recurrence time of 10 days to 1.5 years, left accessory pathway in 2 cases, right accessory pathway in 6 cases, ventricular tachycardia in 3 cases, palpitation in 12 cases, palpitation with pale face and sweating in 7 cases. Palpitation accompanied with nausea, vomiting and other gastrointestinal symptoms in 2 cases (1 cases) with syncope as the main manifestation of 5 cases of precardiac discomfort, precardiac region of distention, fatigue and other manifestations. Arrythmia induced by upper respiratory tract infection accounted for 2 cases of arrhythmia induced by intense exercise and 1 case of arrhythmia induced by emotional tension. Among the patients with recurrence after radiofrequency ablation, 5 cases were caused by reinfection of upper respiratory tract. One case was caused by severe exercise. The immediate success rate of recurrence was 100%. The follow-up period was 12 months to 59 months, with an average of 30 卤17 months. The success rate was 100%. The accessory pathway was atrioventricular nodal reentrant in 4 cases for the first time, in which 1 case was found to be idiopathic ventricular tachycardia with left posterior branch origin, 1 case with left accessory pathway, 1 case with left posterior branch pathway and 1 case with atrioventricular nodal reentry. One case of right accessory pathway with frequent atrial premature beats and left ventricular enlargement still had preexcitation syndrome after the first operation. One case had moderate tricuspid regurgitation after reoperation one year later, the QT value was high after operation, and the heart rate variability of dynamic electrocardiogram (ECG) was poor. Conclusion incomplete ablation and omission of potential residual pathways are the main reasons for the failure of ablation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.4

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