■心脏神经消融(CNA)对于因迷走神经过度紧张而引起的严重症状性心动过缓的成年人来说是一种有希望的治疗选择。然而,迄今为止还没有儿科病例的报道.因此,这项研究的目的是评估儿童CNA的可行性和有效性。
■一名12岁男性患者因疲劳症状住院,心悸,晕厥超过2个月,通过12导联心电图明确诊断为功能性窦房结功能障碍,24小时Holter监测,阿托品试验负荷剂量(0.04mg/kg),和跑步机运动测试。同时,对患儿及其核心家庭成员进行了全外显子组测序.完成术前检查并签署知情同意书后,患儿接受了CNA治疗.
■首先,使用Carto3系统绘制了两个心房的电解剖结构,根据纯解剖引导和局部分割心内电描记图引导CNA方法的协议。然后,每个心神经节丛(GP)的局部分割心内电描记图,包括主动脉根部和上腔静脉内壁之间的GP,冠状窦口后壁和左心房之间的GP,右上肺静脉前窦和上腔静脉之间的GP,左上肺静脉根部周围的上外侧区域的GP,右下肺静脉根部周围的GP,和左下肺静脉根部周围的GP,作为消融目标,功率为30W,消融指数为350-400。在6个月的随访中,孩子的心律完全恢复为窦性心律,临床症状消失。
■在有症状的窦性心动过缓患儿中首次应用CNA取得了更好的临床效果。在适当的适应症下,儿童可以谨慎地进行CNA。
UNASSIGNED: Cardioneuroablation (CNA) is recognized as a promising therapeutic option for adults with severe symptomatic bradycardia caused by excessive vagal tone. However, no pediatric cases have been reported to date. Therefore, the aim of this study is to evaluate the feasibility and efficacy of CNA in children.
UNASSIGNED: A 12-year-old male patient was hospitalized with symptoms of fatigue, palpitations, and syncope for more than 2 months, and was definitively diagnosed with functional sinoatrial node dysfunction by using a 12-lead electrocardiogram, 24-h Holter monitoring, loading dose of atropine test (0.04 mg/kg), and treadmill exercise test. Simultaneously, whole-exome sequencing was performed on the child and his core family members. After completing the preoperative examination and signing the informed consent form, the child underwent CNA therapy.
UNASSIGNED: First, the electroanatomic structures of both atria were mapped out by using the Carto 3 system, according to the protocol of purely anatomy-guided and local fractionated intracardiac electrogram-guided CNA methods. Then, the local fractionated intracardiac electrograms of each cardiac ganglionated plexus (GP), including the GP between the aortic root and the medial wall of the superior vena cava, the GP between the posterior wall of the coronary sinus ostium and the left atrium, the GP between the anterior antrum of the right superior pulmonary vein and the superior vena cava, the GP in the superolateral area around the root of the left superior pulmonary vein, the GP around the root of the right inferior pulmonary vein, and the GP around the root of the left inferior pulmonary vein, were used as targets for ablation at a power of 30 W with an ablation index of 350-400. At a 6-month follow-up, the child\'s heart rhythm saw a complete restoration to sinus rhythm and clinical symptoms disappeared.
UNASSIGNED: The first application of CNA in a child with symptomatic sinus bradycardia was achieved with better clinical outcomes. CNA can be carried out cautiously in children under suitable indications.