在有创电生理学研究中,无诱发性可重入性室上性心动过速患儿的慢路径消融。

M Emmel, K Brockmeier, N Sreeram
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引用次数: 14

摘要

无标记:射频导管消融(RFA)已成为永久治疗房室结性再入性心动过速(AVNRT)的首选方法。本报告介绍了我们在有记录的狭窄复杂再入性SVT患者的房室结(AVN)改变的经验,但没有证据表明有辅助通路,并且在有创性电生理(EP)研究中没有诱发性心动过速。方法:研究人群包括9名儿童,年龄范围6-13岁(中位数9岁),既往有SVT记录,在EP研究期间(基线和异丙肾上腺素输注后)无诱发性心动过速。9例EP研究中有8例在全身麻醉下进行,1例在清醒镇静下进行。通过适当的心房和心室外刺激起搏技术排除了所有患者的辅助通路。9例患者中8例有双房室结生理,1例有单房室结回声节拍。通过将射频病变应用于右室间隔间室沟,使导管尖端温度达到50摄氏度,实验性地消融慢房室结通路。射频应用过程中出现加速的结期节律被认为是成功的应用部位。通过增量心房起搏确认射频应用期间的房室传导。使用LocaLisa导航系统持续监测导管位置及其与紧凑房室结的关系。终点为无双房室神经生理和/或房室结回声搏动。结果:所有患者均成功实现慢路径消融。一名患者似乎有两个不同位置的独立缓慢通路和两个ah跳,都成功消融了。随访时,没有患者有暂时或永久性房室传导阻滞的证据(中位持续时间9个月,范围4至36个月);没有人有症状复发或记录的心动过速。结论:对于结构正常的心脏,先前记录的SVT,缺乏辅助通道和在EP研究期间SVT不可诱导的儿童,经验缓慢通道消融似乎是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Slow pathway ablation in children with documented reentrant supraventricular tachycardia not inducible during invasive electrophysiologic study.

Unlabelled: Radiofrequency catheter ablation (RFA) has become the procedure of choice for permanent therapy of atrioventricular nodal reentrant tachycardia (AVNRT). This report presents our experience with atrio-ventricular node (AVN) modification in patients with documented narrow complex reentrant SVT, but no evidence for an accessory pathway, and no inducible tachyarrhythmia during invasive electrophysiology (EP) study.

Methods: The study population consists of nine children, age range 6-13 years (median 9) with previously documented SVT who had no tachyarrhythmia inducible during EP study (at baseline and following isoprenaline infusion). Eight of the 9 EP studies were performed under general anesthesia, and one under conscious sedation. An accessory pathway was excluded in all patients by appropriate atrial and ventricular extrastimulus pacing techniques. Eight of the nine patients had dual AV nodal physiology, and one had single AV nodal echo beats. The slow AV nodal pathway was empirically ablated, by applying RF lesions in the right inferoseptal AV groove, achieving catheter tip temperature of 50 degrees C. The appearance of an accelerated junctional rhythm during RF application was deemed to denote a successful application site. AV conduction during RF application was confirmed by incremental atrial pacing. The catheter position, and its relation to the compact AV node was constantly monitored using the LocaLisa navigation system. The end-point was absence of dual AVN physiology, and/or AV nodal echo beats.

Results: Successful slow pathway ablation was achieved in all patients. One patient appeared to have two separate slow pathways with different locations and two AH-jumps, which were both successfully ablated. None of the patients had evidence of temporary or permanent AV block at follow-up (median duration 9 months, range 4 to 36 months); none has had recurrence of symptoms or documented tachyarrhythmia.

Conclusions: In children with structurally normal hearts, a previously documented SVT, absence of an accessory pathway and noninducibility of SVT during EP study, empirical slow pathway ablation appears to be justified.

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