CAJ | 학술논문

目的简化经导管标测和消融儿童左后分支性室性心动过速的方法.方法窦性心律下,在后间隔(冠状静脉窦口下缘1～2 cm)的区域内,标测分支电位,其表现为心室波之前的双向波,两者之间存在明确的等电位线;当消融导管标测该电位较希氏柬电位晚20ms以上时试放电;放电前双角度(LAO 45°和30°)观察消融导管的位置,确定不在希氏束处;心电图出现左后分支阻滞,说明消融有效.消融术后心电监测24～48 h,注意室速终止后复极变化;服阿司匹林2～3 mg/kg 3个,月,停服抗心律失常药物,术后1d复查体表心电图、胸片、超声心动图,出院后1个月、3个月各随访一次,此后每半年门诊定期复查或电话随访.结果 15例患儿成功消融,术后心电图均出现左后分支阻滞图形;随访3～12个月,所有出现左后分支阻滞的患儿均无复发.其中1例术中靶点位置好的患儿,试放电后,心电图无改变,仍出现室速,后重新标测,试放电后出现左后分支阻滞,巩固90 s,成功消融,随访6个月,无复发.结论射频消融分支电位治疗儿童左后分支性室性心动过速,简化了标测,减低了手术的难度,消融终点更为可靠.
목적 간화경도관표측화소융인동좌후분지성실성심동과속적방법.방법 두성심률하,재후간격(관상정맥두구하연1～2 cm)적구역내,표측분지전위,기표현위심실파지전적쌍향파,량자지간존재명학적등전위선;당소융도관표측해전위교희씨간전위만20ms이상시시방전;방전전쌍각도(LAO 45°화30°)관찰소융도관적위치,학정불재희씨속처;심전도출현좌후분지조체,설명소융유효.소융술후심전감측24～48 h,주의실속종지후복겁변화;복아사필림2～3 mg/kg 3개,월,정복항심률실상약물,술후1d복사체표심전도、흉편、초성심동도,출원후1개월、3개월각수방일차,차후매반년문진정기복사혹전화수방.결과 15례환인성공소융,술후심전도균출현좌후분지조체도형;수방3～12개월,소유출현좌후분지조체적환인균무복발.기중1례술중파점위치호적환인,시방전후,심전도무개변,잉출현실속,후중신표측,시방전후출현좌후분지조체,공고90 s,성공소융,수방6개월,무복발.결론 사빈소융분지전위치료인동좌후분지성실성심동과속,간화료표측,감저료수술적난도,소융종점경위가고.
Objective To simplify the methods of transcatheter mapping and ablation in the pediatric patients with left posterior fascicular tachycardia. Method While in sinus rhythm, the fascicular potential can be mapped at the posterior septa]region (1-2 cm below inferior margin of orifice of coronary sinus vein), which display a biphasic wave before ventricular wave, and exist equipotential lines between 3 months,and antiarrhythmic drug was discontinued. Surface electrocardiogram, chest X-ray and ultrasound cardiography were rechecked 1 d after operation. Follow-up was made at 1 month and 3 months post-discharge. Recheck was made half-yearly or follow-up was done by phone from then on. Result Fifteen pediatric patients were ablated successfully, and their electrocardiograms all displayed left posterior fascicular block after ablation. None of the patients had recurrences during the 3 to 12 months follow-up period. In one case, the electrocardiogram did not change after applying radiofrequency ablation and the ventricular tachycardia remained; however, on second attempt after remapping, the electrocardiogram did change. The radiofrequency lasted for 90 seconds and ablation was successful This case had no recurrences at 6 months follow-up. Conclusion Transcatheter ablation of the fascicular potential in pediatric patients with left posterior fascicular tachycardia can simplify mapping, reduce operative difficulty and produce a distinct endpoint for ablation.