Am Heart J：结构性心脏病患儿多旁道更常见

　　美国学者的一项研究表明，在结构性心脏病（SHD）患儿中多旁道更为常见，并且二者均可对消融转归造成负面影响。论文于2012年11月21日在线发表于《美国心脏杂志》（Am Heart J）。

　　罹患Ebstein畸形和心肌病等SHD时可出现多旁道。结构性缺损可影响快速心律失常的耐受性，并可使用治疗和消融复杂化。此项研究以接受有创电生理检查的心脏病患儿为受试者，并对多旁道患病率以及多旁道和SHD对消融转归的影响进行了评估。

　　结果显示，在1088例患儿中共发现1288条旁路，其中右侧、间隔和左侧分别占18%、39%和43%。111例（10%）患者存在多旁道，其中涉及250条独立旁路。SHD使多旁道风险升高3倍。多旁道的多变量校正危险因素包括Ebstein畸形和心肌病。1306例次消融的短期成功率为94%，复发率为8%。消融成功受SHD而非多旁道影响。SHD和多旁道患儿复发率较高。

Multiple accessory pathways in the young: The impact of structural heart disease

Background

The presence of multiple accessory pathways (MultAP) is described in structural heart disease (SHD) such as Ebstein's anomaly and cardiomyopathies. Structural defects can impact the tolerability of tachyarrhythmia and can complicate both medical management and ablation. In a large cohort of pediatric patients with and without SHD undergoing invasive electrophysiology study, we examined the prevalence of MultAP and the effect of both MultAP and SHD on ablation outcomes.

Methods

Accessory pathway number and location, presence of SHD, ablation success, and recurrence were analyzed in consecutive patients from our center over a 16-year period.

Results

In 1088 patients, 1228 pathways (36% retrograde only) were mapped to the right side (TV) in 18%, septum (S) in 39%, and left side (MV) in 43%. MultAP were present in 111 pts (10%), involving 250 distinct pathways. SHD tripled the risk of MultAP (26% SHD vs 8% no SHD, P < .001). Multivariable adjusted risk factors for MultAP included Ebstein's (OR 8.7[4.4-17.5], P < .001) and cardiomyopathy (OR 13.3[5.1-34.5], P < .001). Of 1306 ablation attempts, 94% were acutely successful with an 8% recurrence rate. Ablation success was affected by SHD (85% vs 95% for no SHD, P < .01) but not by MultAP (91% vs 94% for single, P = .24). Recurrence rate was higher for SHD (17% SHD vs 8% no SHD, P < .05) and MultAP (19% MultAP vs 8% single, P < .001).

Conclusions

MultAP are found in 10% of pediatric patients, and are more common in SHD compared to those with normal hearts. Both the presence of MultAP and SHD negatively influence ablation outcomes.