CAJ | 학술논문

目的探讨Carto三维电解剖标测系统指导下射频消融及心耳切除术对小儿起源于心耳房性心动过速(房速)的疗效以及起源于心耳房速的心电图特征.方法因房速接受Carto电解剖标测射频消融患儿17例中证实为起源于心耳部位的房速5例,年龄3.2～12.8(8.1±4.6)岁,分析本5例患儿临床资料、心电图特点.应用Carto电解剖标测对相应心耳行冷盐水灌注射频导管消融,射频消融术后复发病例行外科心耳切除并观察其疗效.结果全部接受三维电解剖标测射频消融房速患儿17例中,5例(29％)起源于心耳部位,其中3例起源于右心耳,2例起源于左心耳.Carto激动图提示电生理机制均为局灶性自律性增高.5例患儿即刻消融成功率100％,随访2～15个月,3例(60％)复发,分别于消融术后1周、1、2.5个月接受心耳切除术,夹闭心耳即刻转复为窦性心律,术后随访5～14个月,房速无复发.3例右心耳房速患儿心动过速时体表心电图P波特点:①Ⅰ、aVL导联为正向P波；②Ⅱ、Ⅲ、aVF导联P波直立；③V1导联P波为负向且为双峰.2例左心耳房速患儿心动过速时体表心电图P波特点:①Ⅰ、aVL导联为负向P波；②Ⅱ、Ⅲ、aVF导联P波直立；③V1导联P波直立(1例),或以直立为主的正负双向(1例).结论 ①在儿童局灶性房速中,起源于心耳部位者有独特的心电图特点；②Carto电解剖标测指导冷盐水消融成功率高,但术后易复发；③心耳切除术对起源于心耳房速的疗效可靠,术前需经Carto电解剖准确标测明确房速起源于心耳.
목적 탐토Carto삼유전해부표측계통지도하사빈소융급심이절제술대소인기원우심이방성심동과속(방속)적료효이급기원우심이방속적심전도특정.방법 인방속접수Carto전해부표측사빈소융환인17례중증실위기원우심이부위적방속5례,년령3.2～12.8(8.1±4.6)세,분석본5례환인림상자료、심전도특점.응용Carto전해부표측대상응심이행랭염수관주사빈도관소융,사빈소융술후복발병례행외과심이절제병관찰기료효.결과 전부접수삼유전해부표측사빈소융방속환인17례중,5례(29％)기원우심이부위,기중3례기원우우심이,2례기원우좌심이.Carto격동도제시전생리궤제균위국조성자률성증고.5례환인즉각소융성공솔100％,수방2～15개월,3례(60％)복발,분별우소융술후1주、1、2.5개월접수심이절제술,협폐심이즉각전복위두성심률,술후수방5～14개월,방속무복발.3례우심이방속환인심동과속시체표심전도P파특점:①Ⅰ、aVL도련위정향P파；②Ⅱ、Ⅲ、aVF도련P파직립；③V1도련P파위부향차위쌍봉.2례좌심이방속환인심동과속시체표심전도P파특점:①Ⅰ、aVL도련위부향P파；②Ⅱ、Ⅲ、aVF도련P파직립；③V1도련P파직립(1례),혹이직립위주적정부쌍향(1례).결론 ①재인동국조성방속중,기원우심이부위자유독특적심전도특점；②Carto전해부표측지도랭염수소융성공솔고,단술후역복발；③심이절제술대기원우심이방속적료효가고,술전수경Carto전해부준학표측명학방속기원우심이.
Objective To investigate the effects of radiofrequency catheter ablation (RFCA) under guidance of three dimensional electroanatomic mapping system (Carto) combined with appendectomy to cure atrial tachycardia(AT) originating from atrial appendages in children.And to evaluate the electrocardiographic characteristics.Methods Of the 17 children with AT receiving RFCA under Carto system in our electrophysiology laboratory(EPL),5 were diagnosed as AT originating from atrial appendages,age 3.2 ～ 12.8 (8.1 ±4.6)years.Clinical data and electrocardiographic characteristics of these 5 children were retrospectively analyzed.Ablations were performed by cold saline infused catheter at appendages targeting loci of AT origin under guidance of Carto system.For those recurred after RFCA,appendectomies were performed.Results Of the 17 children with AT receiving RFCA under Carto system,5 (29％) originated from atrial appendages.Three were from right atrial appendage (RAA) and 2 were from left atrial appendage(LAA).Three dimensional mapping portraits revealed increased focal automaticity.Immediate success rate for RFCA was 100％.Three recurred (60％) during follow-up period (2 ～ 15months).Appendectomies were performed in them individually at 1 week,1 month and 2.5 months after RFCA.During operations,heart rhythm immediately reversed to sinus while appendages were clenched.No recurrence was detected during 5 ～ 14 months follow-up.Characteristics of P wave configuration for AT from RAA were:①positive P wave in Ⅰ and aVL leads;②positive P wave in Ⅱ,Ⅲand aVF leads ;③negative and double-peak P wave in V1 lead.Characteristics of P wave configuration for AT from LAA were:①negative P wave in Ⅰ and aVL leads;② positive P wave in Ⅱ,Ⅲ and aVF leads;③positive P wave in V1 lead (1 case)or bidirectional P wave with positive tendency (1 case).Conclusions ① The electrocardiographic characteristics of AT originating from atrial appendages in children are peculiar; ② RFCA under Carto mapping system by cooled tip cather is safe and effective for AT originating from atrial appendages in children while recurrence rate is high; ③ Appendectomy for AT originating from atrial appendage is reliable,while the accurate location of AT origin should be determined by Carto mapping system preoperatively.