【摘要】 目的探讨无器质性心脏病儿童室性早搏(室早)导管消融治疗的安全性和有效性。方法本中心2004年1月至2007年6月导管消融治疗的27例无器质性心脏病儿童的频发室早病例,年龄2～14(7.75±3.48)岁。其中多数患儿有明显的室早相关症状(74.07%),所有患儿动态心电图室早≥20000个/24 h[平均(30350±14180)个/24 h],平均病史(3.2±1.9)年,药物治疗无效或不能耐受。静脉全身麻醉配合局部麻醉下采用室早激动顺序标测与窦性心律起搏标测进行室早起源定位行导管射频消融术。结果 27例患儿中25例消融即刻成功,1例未能诱发,另1例消融未成功,消融即刻成功率(92.59%),平均放电时间(582±216)s,平均 X 线曝光时间(33±8)min。诱发出室早的26例中室早起源于右心室流出道24例(右心室流出道间隔部13例,右心室肺动脉瓣下近间隔处3例,右心室流出道近游离壁处6例,间隔与游离壁两处起源2例),起源于左心室流出道2例。无心脏压塞、永久性房室阻滞并发症。术后1周内复查动态心电图室早平均(590±354)个/24 h(均<1000个/24 h)。结论导管消融可用于治疗药物治疗无效或不能耐受药物治疗的无器质性心脏病儿童的症状性频发室早,安全、有效、即刻成功率高。建议从严掌握导管消融适应证:(1)频发室早≥20000个/24 h或≥1000个/h;(2)症状性室早;(3)运动或情绪激动下易发;(4)病程长,病情呈逐渐加重趋势;(5)药物治疗无效或不能耐受;(6)因影响正常升学家属强烈要求治疗。更多还原

【Abstract】 Objective The aim of this study is to evaluate the indication and clinical effects of ra- diofrequency catheter ablation(RFCA)for premature ventricular contractions(PVCs)in pediatric patients without structural heart diseases.Methods Tweenty-seven pediatric patients with episodes of PVCs in the absence of structural heart diseases were included[mean age(7.75±3.48)years,range 2 to 14].Se- vere clinical symptoms were observed in 74.07% of the patients.All of the patients’Hoher:PVCs≥ 20000/24 h[30350±14180)/24h].With general intravenous anesthesia and local anesthesia,the pacing mapping and/or activation mapping were used for noting the site during the RFCA proce- dure.Results PVCs were successfully ablated in 25 cases.No ablation-related complications happened. Among 26 cases who were induced PVCs during RFCA,PVC originated from right ventricular outflow tract in 24 cases,and from left ventricular outflow tract in 2 cases.During the follow-up of 1 week after RFCA, Hoher records of the successfully ablated patients indicated mean PVC(590±354)/24h.Conclusions RFCA is a safe and effective method for the treatment of PVCs in pediatric patients without structural heart diseases.But the indication of RFCA should be strict:(1)frequent PVC≥20000/24h or ≥ 1000/h; (2)symptomatic PVC;(3)episode during exercise or activity;(4)long course and aggravation;(5)ineffi- cacy of antiarrhythmic drugs;(6)depressed quality of life.更多还原