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目的探讨射频消融治疗小儿Ebstein畸形合并房室折返性心动过速的疗效、安全性及其影响因素。方法分析2009年1月至2011年6月在清华大学第一附属医院接受射频消融治疗的8例Ebstein畸形合并房室折返性心动过速患儿临床资料,总结体表心电图表现、旁路数量及部位、射频消融标测方法及疗效。结果 8例患儿射频消融前体表心电图表现为显性预激者5例,间歇性预激者1例,未见典型预激波2例。心内电生理学检查共发现9条房室旁路,其中右后壁旁路5条、右中间隔旁路2条、右后间隔旁路2条。9条房室旁路中共8条被成功消融(88.9%),1例右后间隔旁路因消融电极难以稳定贴靠三尖瓣环消融未能成功。4例患儿因消融电极贴靠不稳定而选用Swartz鞘辅助。5例患儿于射频消融术后接受了Ebstein畸形矫治手术。结论 Ebstein畸形合并的房室旁路主要位于右后壁及右后间隔;对于小儿Ebstein畸形合并房室折返性心动过速患儿,矫治术前选择射频消融是安全而有效的治疗手段。对比显性预激窦性心律下标测AV融合点作为消融靶点,消融术中采用心室起搏或心动过速下标测VA融合点更为可靠和有效。
Objective To investigate the efficacy, safety and influencing factors of radiofrequency ablation in the treatment of Ebstein’s malformation combined with atrioventricular reentrant tachycardia in children. Methods The clinical data of 8 children with Ebstein’s malformation combined with atrioventricular reentrant tachycardia who underwent radiofrequency ablation at the First Affiliated Hospital of Tsinghua University from January 2009 to June 2011 were analyzed. The changes of body surface electrocardiogram, number of bypass and Location, radiofrequency catheterization mapping method and efficacy. Results The electrocardiogram of radiofrequency ablation in 8 cases showed dominant pre-excitation in 5 cases, intermittent pre-excitation in 1 case, and no typical pre-shock in 2 cases. Cardiac electrophysiology examination found a total of 9 atrioventricular bypass, of which 5 right bypass wall bypass, the right middle of the bypass 2, right after the bypass 2. 8 of 9 atrioventricular shunts were successfully ablated (88.9%), and 1 of the right posterior septal bypass was unsuccessful due to the difficulty of ablating the tricuspid annulus ablation. Four patients were selected for Swartz sheath aids because of the instability of ablation electrodes. Five children underwent ebstein malformation surgery after radiofrequency ablation. Conclusion Ebstein’s malformation combined with atrioventricular shunt is mainly located in the right posterior wall and posterior septum. For children with Ebstein’s malformation and atrioventricular reentrant tachycardia, preoperative radiofrequency ablation is a safe and effective treatment. Contrast to the dominant pre-excitation sinus rhythm AV fusion point mapping as the ablation target, ablation technique using ventricular pacing or tachycardia measured VA fusion point more reliable and effective.