三维电生理标测系统在儿童心律失常导管消融中的应用

目的 探讨三维标测系统(Carto和Ensite)在指导儿童心律失常导管消融中的安全性、适应证和优越性.方法 ①在Carto指导下房性心动过速(atrial tachycardia,AT)消融8例;年龄(6.2±1.7)岁,体重(18.0±2.0)kg.②在Ensite指导下心律失常消融10例.其中应用Ensite Array系统指导消融8例,包括频发右室室性早搏(premature ventricular contractions,PVCs)6例,右房AT2例,年龄(11.3±1.2)岁,体重(40.0±5.0)kg;应用Ensite NavX系统指导消融2例,为B型预激综合征.结果 ①在Carto指导下8例AT患儿成功消融,其中"切口"性AT6例,左房耳AT和右房AT各1例;1例"切口"AT术后3个月复发,再次消融成功.②在Ensite Array指导下6例频发右PVCs和2例右房AT患儿成功消融,其中PVCs从术前(32 333±4509)个/24 h下降至0～4个/24 h;1例AT患儿1 d后出现另一种周期的AT.在Ensite Navx指导下成功消融2例B型预激综合征.随访6个月无复发.结论 Carto系统适合持续心律失常患儿的检测,而Ensite Array系统适合大于10岁、不持续右心心律失常患儿的检测;Ensite NavX可迅速建模,显示心内解剖结构.

Radiofrequency catheter ablation of arrhythmias in pediatric patients guided by three-dimensional mapping system

Objective To explore safety, indications and advantages of mapping and ablation of arhythmia in children guided by Carto and Ensite system. Methods Guided by Carto system, radiofrequeney catheter ablation (RFCA) was performed on 8 pediatric patients with tachycardia whose mean age was (6.2±1.7) years, mean weight was (18.0±2.0) kg. Guided by Easite system, RFCA was performed on 10 pediatric patients with arhythmia, 8 of them were ablated guided by Ensite Array system: 6 cases with premature ventricular contractions (PVCs), 2 cases with right atrial tachycardia, their mean age was (11.3±1.2) years, and mean weight (40. 0±5.0) kg. The other two cases with W-P-W syndrome were ablated guided by Ensite Navx system. Result Guided by Carto system, 8 cases were successfully mapped and ablated: 6 cases had incision atrial tachycardia, 1 case had left atrial tachycardia and 1 case had right atrial tachycardia. In 1 case with incision atrial tachycardia the condition recurred after 3 months,and was ablated again successfully. Guided by Ensite Array system, 6 cases with PVCs (in 2 originating from the right ventricular inflow tract and in 4 originating from the fight ventricular outflow tract) and 2 cases with right atrial tachycardia were successfully mapped and ablated, PVCs of the first 6 cases were reduced from (32 333±4509)24 h to (0-4)/24 h after ablation. In 1 case with automatic atrial tachycardia,mapping could not be done by Easite Array system, because P wave could not be identified from T wave.Single bolus of adenosine 20 mg was given within 30 s to let ventricles stop for 2 s (cardioventricular pacing standby) until T wave vanished, mapping and ablation were operated again successfully, but another atrial tachycardia occurred 1 day later. Guided by Ensite Navx system, 2 cases with W-P-W syndrome were successfully ablated, operation under X-rays lasted for 8 and 10 min. In none of the 9 patients the disease recurred after follow-up for 6 months. Conclusion Carto system is suitable for mapping and ablation in pediatric patients with continuous tachycardia, especially with incision atrial tachycardia; Ensite Array system fits children older than 10 years with fight heart discontinuous arhythmia; and Ensite NavX system can set up model and display endocardial anatomic structure quickly. Compared with two-dimensiomal mapping system, the three-dimensional mapping system (Carto and Ensite) can display the origin of arrhythmia and activation sequence clearly, decrease difficulty of operation efficiently and diminish operation time under X-ray.