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目的探讨小儿右侧旁道的临床特点及射频消融效果。方法对2000年3月至2013年9月于我中心拟行射频消融的164例儿童右侧旁道患者进行分析。结果 164例患儿(年龄8个月~19岁)中,显性旁道65例,其中5例合并先天性心脏病;4例合并扩张型心肌病;6例超声提示室壁运动异常和/或左室扩大。157例患者行射频消融治疗,总体消融成功率为98.7%,2例合并右室双出口的患者消融失败。4例合并扩张型心肌病的患者经成功射频消融后心脏射血分数恢复至正常,左室舒张末径回缩至接近正常。6例合并室壁运动异常及左室扩大的患者消融后恢复正常。结论儿童右侧旁道可能合并器质性心脏病,显性心室预激亦可能导致室壁运动异常及左室扩大,因此,消融术前应常规行超声心动图检查。儿童右侧旁道行射频消融术是安全、有效的方法,若合并先天性心脏病,消融难度加大。应用Swartz鞘辅助消融右侧游离壁旁道时,可提高消融成功率,减少复发。
Objective To investigate the clinical features and radiofrequency ablation of the right accessory pathway in children. Methods From March 2000 to September 2013 in our center for radiofrequency ablation of 164 cases of children with right side of the bypass were analyzed. Results Of the 164 children (age ranged from 8 months to 19 years), there were 65 cases of dominant collateral pathways, of which 5 cases had congenital heart disease, 4 cases had dilated cardiomyopathy, 6 cases showed abnormal wall motion and / Or left ventricular enlargement. 157 cases of patients underwent radiofrequency ablation, the overall success rate of ablation was 98.7%, 2 patients with right ventricular dual outlet ablation failure. In 4 patients with dilated cardiomyopathy, the ejection fraction of the heart returned to normal after radiofrequency ablation and left ventricular end-diastolic diameter contracted to near normal. Six patients with abnormal wall motion and left ventricular enlargement returned to normal after ablation. Conclusion The right accessory pathway in children may be complicated by organic heart disease. The dominant ventricular pre-excitation may lead to abnormal wall motion and left ventricular enlargement. Therefore, echocardiography should be performed routinely before ablation. Radiofrequency ablation of the right side of the bypass line is a safe and effective method for children with congenital heart disease, ablation more difficult. Application Swartz sheath to help bypass the right side of the free-path bypass, can improve the success rate of ablation and reduce recurrence.