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題名 | Radiofrequency Catheter Ablation of Supraventricular Tachycardias in Pediatric Patients=以電氣燒灼術治療兒科病人之心室上性心搏過速 |
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作者姓名(中文) | 張永青; 吳美環; 林俊立; 楊明倫; 王主科; 呂鴻基; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 36:2 民84.03-04 |
頁次 | 頁113-120 |
分類號 | 417.5226 |
關鍵詞 | 電氣燒灼術; 心室上性心搏過速; 兒科; Radiofrequency ablation; Supraventricular tachycardia; Pediatric; |
語文 | 英文(English) |
中文摘要 | 心室上性心搏過速是兒童最常見的心律不整,其中尤以房室結及房室間週旋型心搏過速佔多數,近年來電氣燒灼術已成爲成人病患治療之首要選擇,在這份報告中,我們特別提出應用於兄科病人之初期經驗。六名病人(年齡介於5至22歲,平均年齡爲13歲,三男三女)於1993年7月至同年10月間,至本院接受電氣生理檢查及燒灼前治療,症狀爲期1年至15年(平均爲5年),曾服用包括貝他型阻斷劑及鈣離子通道阻斷劑等抗心律不整藥物,不過效果均不理想。四名病患是以左側之附加通路爲其迴旋路腺之逆向通道,在辨識出心房最早去極化處,即以7號大頭電極導管,由左心室倒勾至僧帽瓣緣進行灼燒;另兩名則爲房室結迴旋型心搏過速,燒灼用電極導管放在三尖瓣緣之後下方,並由漫通路雷圖來輔助導引定位。電氣灼燒能量在房室間迴旋型心搏過速病人給了4至6次,每次平均40秒,而房室結迴旋型心搏過速病人則給一次即可,能量在15至25瓦特之間,結果所有6名病人均告成功,並無任何併發症産生,追蹤3至7個月都沒有復發的情況。由這些初步的經驗,我們結論認爲電氣燒灼術,應是項有效而且安全的方法,可以應用在兒科心室上性心搏過速病患之治療。 |
英文摘要 | Supraventricular tachycardia (SVT) is the most common cardiac a1rhythmia in children. Atrioventricular (AV) reciprocating tachycardia utilizing an accessory pathway and AV nodal reentrant tachycardia (AVNRT) constitute a majority of SVTs. Radiofrequency energy ablation has recently become the treatment of choice in adults. Initial experience in pediatric patients in this Institute is reported in this study. Six consecutive patients (aged 5-22 years, mean age 13 years; 3 boys, 3 girls) with narrow-QRS SVT were studied from July to October in 1993. They had experienced symptomatic SVT for a mean period of five years (ranged from 1 to 15 years). Anti-arrhythmic agents, including beta-antagonists and calcium channel blockers, were unable to satisfactorily suppress these SVTs. Four of the six patients were shown to have a left-sided concealed accessory connection as the retrograde limb of the reentrant circuit. After identification of the earliest retrograde activation site, a steerable 7F catheter with a 4-mm-long electrode at the distal tip was placed within the left ventricle and positioned against the atrio-ventricular annulus. Another two patients were proved to have AVNRT. The ablation catheter was placed at the posterior/inferior aspect of the tricuspid annulus and guided by putative slow potential. Radiofrequency current was delivered at a power from 15 to 25W for four to six times with a mean duration of 40 seconds in patients with AV reciprocating tachycardia, and a single time in those with AVNRT. All six SVTs were successfully ablated. No complication was noted in any patient. Follow-up for three to seven months has indicated no recurrence of SVT. Radiofrequency current is an effective and safe energy source for catheter ablation of accessory AV connections and AVNRT in pediatric patients with SVT. |
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