Khongphatthanayothin A, Chotivitayatarakorn P, Benjacholamas V, Muangmingsuk S, Lertsupcharoen P, Thisyakorn C
Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2001 Jun;84 Suppl 1:S111-7.
The etiologies of complete heart block in thirty-one children (mean age 5.5 +/- 5.2 years, range 0-14 years) diagnosed at King Chulalongkorn Memorial Hospital between 1990-2001 were reviewed. Three main groups of patients were identified: 1) patients who presented in utero or in the newborn period (congenital heart block, n = 6), 2) patients who had complete heart block after cardiac surgery (postoperative heart block, n = 10), and 3) children outside the newborn period with a new diagnosis of complete heart block unrelated to cardiac surgery (unknown etiology, n = 15). Among 15 patients in the last group, 5 were asymptomatic (or minimally symptomatic) with complete heart block unexpectedly found. These patients probably had previously undetected congenital heart block. Two patients had complete heart block associated with mild viral illness, but no bradycardia-related symptom. The etiology for heart block in these 2 patients was unknown. Eight patients probably had recent onset heart block because of new bradycardia-related symptoms, or a previously documented normal heart rate. All patients in this group were female (mean age 4.3 +/- 4.3 years, median 3.5 years). All were diagnosed between August and January, and the majority (75%) had a history of non-specific viral illness in the preceding 2 weeks. Seven patients (87.5%) were acutely symptomatic. Syncope and/or seizure were the most common presenting symptoms. Left ventricular systolic dysfunction was found in only one patient. The etiology of complete heart block in these patients probably was an acute viral myocarditis that preferentially affected the conduction system. Two of these eight patients had complete recovery of the atrioventricular conduction. The rest had no improvement or had only partial recovery and subsequently underwent permanent cardiac pacemaker insertion.
回顾了1990年至2001年间在朱拉隆功国王纪念医院确诊的31例儿童（平均年龄5.5±5.2岁，范围0至14岁）完全性心脏传导阻滞的病因。确定了三组主要患者：1）在子宫内或新生儿期出现的患者（先天性心脏传导阻滞，n = 6），2）心脏手术后出现完全性心脏传导阻滞的患者（术后心脏传导阻滞，n = 10），以及3）新生儿期以外新诊断为与心脏手术无关的完全性心脏传导阻滞的儿童（病因不明，n = 15）。在最后一组的15例患者中，5例无症状（或症状轻微），意外发现完全性心脏传导阻滞。这些患者可能之前存在未被发现的先天性心脏传导阻滞。2例患者的完全性心脏传导阻滞与轻度病毒感染有关，但无心动过缓相关症状。这2例患者心脏传导阻滞的病因不明。8例患者可能因新出现的心动过缓相关症状或之前记录的正常心率而近期发生心脏传导阻滞。该组所有患者均为女性（平均年龄4.3±4.3岁，中位数3.5岁）。所有患者均在8月至1月期间确诊，大多数（75%）在之前2周有非特异性病毒感染史。7例患者（87.5%）有急性症状。晕厥和/或癫痫是最常见的首发症状。仅1例患者发现左心室收缩功能障碍。这些患者完全性心脏传导阻滞的病因可能是急性病毒性心肌炎，优先影响传导系统。这8例患者中有2例房室传导完全恢复。其余患者无改善或仅部分恢复，随后接受了永久性心脏起搏器植入。
