Lupoglazoff J-M, Denjoy I
Unité de cardiologie néonatale, hôpital Robert-Debré, Paris, France.
Arch Pediatr. 2004 Oct;11(10):1268-73. doi: 10.1016/j.arcped.2004.02.010.
Arrhythmias in neonates and infants require a specific management due to the particular nature of the rhythm anomalies in children. Accurate diagnosis of the tachycardia is realised mainly by means of ECG recording and vagal manoeuvres. The nature of the tachycardia will determine management, therapy and prognosis. In neonates <3 months, supraventricular tachycardia due to Wolff-Parkinson-White syndrome represents 70% of all supraventricular tachycardias, which, after conversion by vagal manoeuvres, requires a preventive treatment by digoxine (10 y/kg/day tid). Neonatal flutter occurs in infants without structural heart disease. It has an excellent prognosis after conversion to sinus rhythm by transoesophageal pacing. Atrial tachycardia is less frequent but can induce a tachymyocardiopathy and often requires combined therapy including amiodarone. Long QT syndrome, clinically and genetically heterogeneous, is characterized by a prolongation of the QT interval (QTc > 440 ms) and a high risk of syncope and sudden death due to malignant ventricular arrhythmias. Beta-blockers significantly decrease cardiac events during follow-up. Congenital atrio-ventricular block is rare but potentially lethal in the first months of life in the absence of permanent pacing. The morbidity remains high during long term follow-up in unpaced children.
由于儿童心律失常异常的特殊性质，新生儿和婴儿的心律失常需要特殊的管理。心动过速的准确诊断主要通过心电图记录和迷走神经手法来实现。心动过速的性质将决定管理、治疗和预后。在3个月以下的新生儿中，由 Wolff-Parkinson-White 综合征引起的室上性心动过速占所有室上性心动过速的70%，经迷走神经手法转复后，需要用地高辛（10μg/kg/天，每日三次）进行预防性治疗。新生儿扑动发生在无结构性心脏病的婴儿中。经食管起搏转复为窦性心律后，其预后良好。房性心动过速较少见，但可诱发心动过速性心肌病，通常需要包括胺碘酮在内的联合治疗。长QT综合征在临床和遗传上具有异质性，其特征是QT间期延长（QTc>440ms），以及由于恶性室性心律失常导致晕厥和猝死的高风险。β受体阻滞剂在随访期间可显著减少心脏事件。先天性房室传导阻滞很少见，但在生命的最初几个月中，如果没有永久性起搏，可能是致命的。在未起搏的儿童长期随访期间，发病率仍然很高。
