CATHETER ABLATION THERAPY FOR SUPRAVENTRICULAR TACHYCARDIA IN CHILDREN

对14例室上性心动过速的显性或隐匿性Wolff-Parkinson-White综合征患儿进行了射频消融治疗。10岁以上患者的最佳导管长度为7法，10岁以下的患者为6法。6例中有5例记录到旁路电位。旁道电位的位置和最早的心房激动部位并不总是相同的。所有记录到旁路电位的患者射频消融均成功。消融的总能量为20至40瓦秒。所有病例均在几秒钟内消融成功。右侧4条消融成功2条，左侧6条消融成功。显性消融成功4例(44%)，隐匿性消融成功4例(80%)。但间隔部及多径路均未成功。成功率：14例中8例(57%)，15例中8例(53%)。消融成功的部位是：1)Kent电位记录，2)A波幅度等于或大于0.4 mV，3)A/V比值等于或大于0.2，4)在心动过速或室性起搏时测量V峰至A峰的VA或QA间期最短。然而，如果我们使用这些索引，就没有绝对的最佳站点。1例消融后出现中度主动脉瓣返流。该并发症不是消融方法所致，而是导管不灵活所致。导管消融是儿童室上性心动过速的有效治疗方法。

Fourteen cases of supraventricular tachycardia with manifest or concealed Wolff-Parkinson-White syndrome in children were performed radiofrequency catheter ablation. The optimal size of catheter was 7 French in patients over 10 years old, and 6 French in patients less than 10 years old. Accessory pathway potential were recorded in 5 of 6 cases. The position of accessory pathway potential and earliest atrial activation site were not always same. Radiofrequency accessory pathway ablation were succeeded in all cases who were recorded accessory pathway potential. Total energy for ablation was 20 to 40 Watt sec. All cases succeeded ablation in a few seconds. Ablation were succeeded in 2 of 4 right pathways and 6 of 10 left pathways. Ablation were succeeded in 4 of 9 (44%) manifest pathways and 4 of 5 (80%) concealed pathways. However it was unsuccessful in septal and multiple pathway. Success rate was 8 of 14 cases (57%) , 8 of 15 pathways (53%). The successful ablation site was 1) Kent potential documentation, 2) A wave amplitude equal and over 0.4 mV,3) A/V ratio equal and over 0.2,4) shortest VA or QA interval measured from peak V wave to peak A wave during tachycardia or ventricular pacing. However there were no absolute optimal site if we use these indexes. Moderate aortic regurgitation was detected in one case after ablation. This complication was not due to ablation method but due to inflexibility of catheter. Catheter ablation was useful therapy for supraventricular tachycardia in children.