【摘要】 总结应用改进的标测方法和新技术治疗儿童特发性室性心动过速的经验。左室特发性室性心动过速(ILVT)共7例 ,其中ILVT时体表12导联心电图表现为完全右束支阻滞伴左前分支阻滞6例和伴左后分支阻滞1例 ;右室特发性室性心动过速(IRVT)3例 ,其中右室流出道2例和右室流入道1例。年龄8.4±3.2岁 ,体重28.5±13.4kg。①在窦性心律下浦肯野电位法标测ILVT消融靶点 ;②应用二根分别放置在右室流出道和右室流入道电极 ,采用“蛙跳”方法标测较早的心室激动点 ,然后用射频导管在该点附近标测IRVT时最早心室激动点 ;③应用Carto系统标测ILVT。结果显示 ,10例均成功消融 ,放电和透视时间分别为7.0±3.8次和20±8.4分钟 ;应用Carto系统标测2例ILVT ,1例ILVT在靶点附近标测过程中易出现室性早搏 ,难与ILVT鉴别而形成错误的电解剖图 ,导致消融失败。提示改进的标测方法可减少放电次数 ,缩短X线透视时间 ;Carto系统在ILVT(VT时体表12导联心电图表现为完全右束支阻滞伴左前分支阻滞或左后分支阻滞)标测过程中易受室性早搏干扰 ,形成错误的电解剖图而消融失败 ,且费用昂贵和手术时间长更多还原

【Abstract】 To sum up the experience on using improved mapping method and new technique to ablate IVT in children,10children IVT were enrolled in this study.RF current was applied at the site where the high frequency potential near left anterior fascicular or left posterior fascicular was located.Two electrodes were placed in the right ventricular outflow and ventricular inflow.Ablation catheter was positioned at the site where reference electrode recorded the earliest ventricular activation.CARTO system was used to map and ablate two cases with ILVT.The results showed that all10cases were successfully ablated with7.0±3.8RF pulses,the fluoroscopic time was20±8.4min.1case had ventricular extra-systoles in mapping-process when used with Carto system and because cardiac catheter stimulation was near the target,it was difficult to differentiate the ventricular extra-systoles with VT,which caused the failure of the procedure.We conclude that with improved mapping techniques,the RF pulses and fluoroscopic time was significantly reduced in IVT children.In cases with right bundle branch block,Carto system could fail to ablate IVT due to the ex-tra-systoles caused by the disturbance of mapping-process.更多还原