Silvetti M S, Grutter G, Di Ciommo V, Drago F
Cardiac Arrhythmias Service, Cardiology and Heart Surgery Department, Bambino Gesù Pediatric Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
Pediatr Cardiol. 2004 Sep-Oct;25(5):506-12. doi: 10.1007/s00246-004-0647-z. Epub 2004 Jul 30.
We describe 17 patients (8 girls, and 9 boys), aged 9.6 +/- 5.7 years, with paroxysmal atrioventricular block (PAVB), a condition rarely described in children. Holter monitoring documented the PAVB in 15 patients, and tilt test was performed in 4 patients (positive in 1). The electrocardiograph (ECG) was normal in 7 patients. Two patients had acquired and 11 patients had congenital heart disease (CHD). Syncope or presyncope were present in 7 patients. A normal ECG was significantly more frequent in symptomatic patients. Pauses were significantly longer in girls and in children <5 years. PAVB was recorded only during nocturnal hours in 6 patients and throughout the day in the others. The sinus rate decreased during PAVB in 6 patients and increased in 4 (generally younger girls with symptoms). Permanent pacemakers were implanted in 13 patients, including 7 asymptomatic patients with CHD and severe bradycardia. During follow-up (3.7 +/- 2.5 years), 1 patient developed complete AVB. Although PAVB was still present in 91% of paced patients, symptoms did not recur because pacing prevented the pauses. In conclusion, PAVB is a rare arrhythmia. Autonomic nervous system dysfunction seems to play an etiological role and permanent pacing was an effective treatment.
我们描述了17例患者（8名女孩和9名男孩），年龄为9.6±5.7岁，患有阵发性房室传导阻滞（PAVB），这是一种在儿童中很少被描述的病症。动态心电图监测记录了15例患者的PAVB，4例患者进行了倾斜试验（1例阳性）。7例患者的心电图（ECG）正常。2例患者患有后天性心脏病，11例患者患有先天性心脏病（CHD）。7例患者出现晕厥或先兆晕厥。有症状的患者中，正常心电图更为常见。女孩和<5岁的儿童中，停顿时间明显更长。6例患者仅在夜间记录到PAVB，其他患者则全天记录到。6例患者在PAVB期间窦性心率下降，4例（通常是有症状的年轻女孩）窦性心率增加。13例患者植入了永久性起搏器，包括7例无症状的CHD和严重心动过缓患者。在随访期间（3.7±2.5年），1例患者发展为完全性房室传导阻滞。尽管91%的起搏患者仍存在PAVB，但由于起搏防止了停顿，症状未再复发。总之，PAVB是一种罕见的心律失常。自主神经系统功能障碍似乎起病因作用，永久性起搏是一种有效的治疗方法。
