本文選題：兒童 + 射頻導(dǎo)管消融　； 參考：《清華大學(xué)》2016年博士論文

【摘要】：流出道室性心律失常是兒童特發(fā)性室性心律失常的常見形式,射頻導(dǎo)管消融術(shù)是其重要的治療手段。本文旨在探討以解剖為基礎(chǔ)的較大樣本量?jī)和鞒龅朗倚孕穆墒СＩ漕l消融術(shù)的效果、策略及術(shù)前心電圖定位的可靠性,以期為提高消融成功率、減少手術(shù)時(shí)間和X線曝光量提供依據(jù)。本研究分析了因流出道室性心律失常在清華大學(xué)第一附屬醫(yī)院接受射頻導(dǎo)管消融術(shù)的94例兒童電生理及心電圖資料。結(jié)果顯示:(1)94例流出道室性心律失常兒童平均發(fā)病年齡8.36±4.07(2~16)歲;頻發(fā)室性期前收縮占室性心律失常的68.1%(64/94);流出道室性心律失常主要起源于右室流出道(73.4%,69/94)。(2)94例流出道起源室性心律失常射頻消融即時(shí)成功率為92.4%(85/92),放棄消融2例,隨訪復(fù)發(fā)率8.2%(7/85),手術(shù)并發(fā)癥發(fā)生率2.1%(2/94)。采用單側(cè)標(biāo)測(cè)消融的88例,其中右室流出道單側(cè)標(biāo)測(cè)消融的占76.1%(67/88),消融成功率89.6%(60/67),隨訪復(fù)發(fā)率6.7%(4/60)。左室流出道單側(cè)標(biāo)測(cè)消融的占23.9%(21/88),予以消融19例,均獲消融成功(100%),放棄消融2例,隨訪復(fù)發(fā)率為15.8%(3/19)。流出道雙側(cè)對(duì)照標(biāo)測(cè)消融的6例,均獲成功,隨訪無復(fù)發(fā)。(3)兒童流出道室性心律失常心電圖特征與成人類似。(4)目前通用的四種心電圖定位算法對(duì)兒童左室流出道起源室性心律失常定位準(zhǔn)確率偏低:陽性預(yù)測(cè)率為47.4~71.4%,敏感性為36.0%-68.0%,特異性為85.5~91.3%。(5)本組資料中將左室流出道進(jìn)一步細(xì)化分組為左冠竇起源和右冠竇起源組,顯示心電圖對(duì)左冠竇起源的陽性預(yù)測(cè)值、敏感性和特異性均遠(yuǎn)高于右冠竇起源的室性心律失常。本研究顯示兒童流出道室性心律失常以右室流出道起源最多見;射頻導(dǎo)管消融可安全有效的用于治療有臨床癥狀或藥物治療效果不佳及藥物不能耐受的兒童流出道室性心律失常。基于流出道毗鄰結(jié)構(gòu)特點(diǎn),細(xì)化心電圖定位算法分組,可篩選出定位準(zhǔn)確的左冠竇起源的室性心律失常。對(duì)于心電圖算法強(qiáng)烈提示左冠竇起源的室性心律失常者,可直接經(jīng)左冠竇標(biāo)測(cè)消融,以減少手術(shù)操作時(shí)間、對(duì)血管的損傷以及放射線曝光時(shí)間;對(duì)于心電圖不易鑒別的右室流出道間隔或右冠竇的室性心律失常,心電圖特征僅作為參考,部分病例術(shù)中需要實(shí)施雙側(cè)標(biāo)測(cè)或消融,可以增加消融成功率,降低復(fù)發(fā)率。本研究通過較大樣本兒童流出道室性心律失常射頻導(dǎo)管消融的數(shù)據(jù)分析,為改善兒童該類手術(shù)療效提供了可借鑒的經(jīng)驗(yàn)。
[Abstract]:Outflow tract ventricular arrhythmia is a common form of idiopathic ventricular arrhythmias in children. Radiofrequency catheter ablation is an important treatment. The purpose of this study was to investigate the effect, strategy and reliability of electrocardiographic localization of outflow tract ventricular arrhythmias in children based on anatomy, in order to improve the success rate of ablation. Reduce the operation time and X-ray exposure to provide the basis. The electrophysiological and electrocardiographic data of 94 children undergoing radiofrequency catheter ablation due to outflow tract ventricular arrhythmia in the first affiliated Hospital of Tsinghua University were analyzed. The results showed that the average onset age of 94 children with outflow tract ventricular arrhythmia was 8.36 鹵4.07 ~ 216 years old. Frequent premature ventricular contraction accounted for 68.1% of ventricular arrhythmias, and outflow tract ventricular arrhythmias mainly originated from right ventricular outflow tract 73.469 / 94. The immediate success rate of radiofrequency ablation of outflow tract originated ventricular arrhythmias was 92.485 / 92and 2 patients gave up ablation. The recurrence rate was 8. 2% and the operative complication rate was 2. 1% / 94%. In 88 cases of unilateral mapping ablation, 76. 1% of them were ablated by unilateral mapping of right ventricular outflow tract (RVOT). The successful rate of ablation was 89.6% 60 / 67%, and the recurrence rate was 6. 7% / 60%. The left ventricular outflow tract with unilateral ablation accounted for 23.9% of 21 / 88 cases, 19 cases were ablated successfully, and 2 cases were abandoned. The recurrence rate was 15.8%. The ablation of the outflow tract was successfully performed in 6 patients with bilateral control. Follow up. 3) electrocardiogram characteristics of outflow tract ventricular arrhythmias in children are similar to those in adults.) the accuracy of four common electrocardiographic localization algorithms for the location of ventricular arrhythmias originating from left ventricular outflow tract in children is low: positive prediction The left ventricular outflow tract was further subdivided into left coronary sinus origin group and right coronary sinus origin group. The positive predictive value, sensitivity and specificity of ECG for the origin of left coronary sinus were significantly higher than that of ventricular arrhythmia derived from right coronary sinus. This study showed that the origin of right ventricular outflow tract was the most common in children with outflow tract ventricular arrhythmia. Radiofrequency catheter ablation is a safe and effective method for the treatment of outflow tract ventricular arrhythmias in children with clinical symptoms or poor drug efficacy and drug intolerance. Based on the characteristics of adjacent structure of outflow tract, the electrocardiographic localization algorithm can be divided into two groups, and the accurate location of ventricular arrhythmias originating from left coronary sinus can be selected. For patients with ventricular arrhythmias originating from left coronary sinus, electrocardiogram (ECG) algorithm strongly suggests that ablation can be performed directly through left coronary sinus mapping in order to reduce operative time, vascular injury and radiation exposure time. For ventricular arrhythmias of right ventricular outflow tract septum or right coronary sinus which are difficult to distinguish by electrocardiogram, the characteristics of ECG are only for reference. In some cases, bilateral mapping or ablation is needed during operation, which can increase the success rate of ablation and reduce the recurrence rate. In this study, the data of radiofrequency catheter ablation of outflow tract ventricular arrhythmias were analyzed in a large sample of children.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R725.7

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