关键词: Ebstein畸形 , 房室折返性心动过速 , 儿童, 射频消融

Abstract:

Objective    To investigate the effectiveness， safety and influencing factors of radiofrequency catheter ablation for atrioventricular reentrant tachycardia combined with Ebstein’s anomaly. Methods    Clinical data of 8 patients diagnosed with Ebstein’s anomaly combined with atrioventricular reentrant tachycardia，who received radiofrequency catheter ablation in our hospital between Jan 2009 and Jun 2011，were retrospectively analyzed， including electrocardiographic presentation， numbers and lo-cations of accessory pathways， mapping strategies and therapeutic effects. Results    Pre-operative electrocardiograms showed dominant preexcitation in 5 patients， incessant preexcitation in 1 and no obvious preexcitation in the other 2 patients. Nine accessory pathways were detected by electrophysiological study，including 5 located at right posterior wall， 2 at right mid-septum and the remaining 2 at right posterior septum. Totally 8 accessory pathways（88.9%） were successfully ablated. A posterior septal pathway was unsuccessfully ablated due to difficulty for the ablating catheter tip to adhere closely to the tricuspid ring. Swartz sheaths were used for 4 patients due to unstability of catheter tip while intending to adhere to target site. Five patients received corrective operation for Ebstein’s anomaly after ablation. Conclusion    Accessory pathways complicated by Ebstein’s anomaly are usually located at right posterior wall and right posterior septum. It is safe and effective for children with Ebstein’s anomaly complicated by atrioventricular reentrant tachycardia to be treated by radiofrequency catheter ablation before surgical correction of cardiac structural anomaly.It is more reliable and effective to map VA fusion during ventricular pacing or tachycardia than to map AV fusion during sinus rhythm.

Key words: Ebstein’s anomaly； atrioventricular , reentrant tachycardia； children； radiofrequency catheter ablation.