脉冲电场消融治疗儿童左心耳起源房性心动过速1例

doi:10.12372/jcp.2025.25e0859

临床儿科杂志 ›› 2025, Vol. 43 ›› Issue (10): 787-791.doi: 10.12372/jcp.2025.25e0859

脉冲电场消融治疗儿童左心耳起源房性心动过速1例

刘福强¹^,²^,^*, 王川¹^,²^,^*, 段泓宇¹^,², 李一飞¹^,², 马凡¹^,², 王芳¹, 周开宇¹^,², 华益民¹^,²()

1.四川大学华西第二医院小儿心血管科（四川成都 610041）
2.四川大学华西第二医院出生缺陷与相关妇儿疾病教育部重点实验室（四川成都 610041）

收稿日期:2025-07-17 录用日期:2025-09-10 出版日期:2025-10-15 发布日期:2025-09-29
通讯作者: 华益民电子信箱：nathan_hua@163.com
作者简介:* 具有同等贡献
基金资助:
四川省科技厅重点研发项目(2024YFFK0272)

Pulsed field ablation for atrial tachycardia originating from left atrial appendage in children: a case report

LIU Fuqiang¹^,²^,^*, WANG Chuan¹^,²^,^*, DUAN Hongyu¹^,², LI Yifei¹^,², MA Fan¹^,², WANG Fang¹, ZHOU Kaiyu¹^,², HUA Yimin¹^,²()

1. The Division of Pediatric Cardiology, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, China
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, Department of Pediatrics, West China Second University Hospital of Sichuan University, Chengdu 610041, Sichuan, China

Received:2025-07-17 Accepted:2025-09-10 Published:2025-10-15 Online:2025-09-29

摘要/Abstract

摘要：

心耳起源房性心动过速（AT）在儿童心律失常中占比高达30%，且常表现为持续性发作，易导致心动过速性心肌病（TIC），传统射频消融在该部位存在成功率低、复发率高及穿孔风险等局限。本文在国内首次报道采用新型压力监测脉冲电场消融（PFA）导管成功治疗1例10岁左心耳起源AT合并TIC男性患儿（34.5 kg），该患儿临床表现为持续心悸伴心功能减低，左室射血分数（LVEF）46%，左室舒张末期内径（LVEDD）48 mm，经心电图特征及三维标测确诊为左心耳远端起源，术中应用新型压力监测PFA导管在接触力约20 g条件下以1 800V脉冲能量精准消融靶点成功终止心动过速，累计消融20 s，术后1个月随访显示无AT复发、心功能显著改善（LVEF 58%，LVEDD 44 mm）且无并发症发生，证实压力监测PFA导管通过实现儿童狭小心耳腔内的精准消融、超短消融时间和实时接触力反馈3大技术优势，为难治性儿童心耳起源AT提供了安全有效的微创治疗新选择，该技术突破对推动儿童复杂心律失常介入治疗发展具有重要意义。

关键词: 脉冲电场消融, 房性心动过速, 心动过速性心肌病, 儿童

Abstract:

A trial tachycardia (AT) originating from atrial appendage in 30% children with AT can often lead to tachycardia cardiomyopathy (TIC) resulted from the AT which is often incessant. Traditional radiofrequency ablation performed at atrial appendage usually is challenging with low success rate, high recurrence rate, and significant risk of pericardial tamponade. This article reports for the first time in China the successful treatment of a 10-year-old boy (34.5 kg) with AT originating from left atrial appendage combined with TIC using a novel contact force sensing pulsed field ablation (PFA) catheter. The clinical manifestations of the child were persistent palpitations with reduced heart function, which was detected by echocardiography with left ventricular end-diastolic diameter (LVEDD) of 48mm and left ventricular ejection fraction (LVEF) of 46%. The focal origin of the AT was confirmed at the distal position of left atrial appendage by the characteristics of 12-lead ECG and local activation time (LAT) map with 3-dimentional mapping system. During the procedure, the AT was successfully terminated using the novel PFA catheter with 1800V pulse-field energy at the contact force of about 20g and the total time of ablation application was 20s. The 1-month follow-up after the operation showed no recurrence of AT, significant improvement in cardiac function (LVEF 58%, LVEDD 44mm), and no complications occurred. This case report preliminarily demonstrated that novel contact force sensing PFA catheter provided a safe and effective strategy for minimally invasive treatment of refractory pediatric arrhythmia originating from atrial appendage by realizing three technical advantages: precise ablation in children's narrow cavity of atrial appendage, ultra-short ablation time and real-time contact force feedback. This technological breakthrough is of great significance for promoting the development of interventional treatment for complex arrhythmias in children.

Key words: pulsed field ablation, atrial tachycardia, tachycardia-induced cardiomyopathy, child

中图分类号:

刘福强, 王川, 段泓宇, 李一飞, 马凡, 王芳, 周开宇, 华益民. 脉冲电场消融治疗儿童左心耳起源房性心动过速1例[J]. 临床儿科杂志, 2025, 43(10): 787-791.

LIU Fuqiang, WANG Chuan, DUAN Hongyu, LI Yifei, MA Fan, WANG Fang, ZHOU Kaiyu, HUA Yimin. Pulsed field ablation for atrial tachycardia originating from left atrial appendage in children: a case report[J]. Journal of Clinical Pediatrics, 2025, 43(10): 787-791.

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参考文献 14

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脉冲电场消融治疗儿童左心耳起源房性心动过速1例

Pulsed field ablation for atrial tachycardia originating from left atrial appendage in children: a case report

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