Ko J K, Deal B J, Strasburger J F, Benson D W
Department of Pediatrics, Northwestern University Children's Memorial Hospital, Chicago, Illinois.
Am J Cardiol. 1992 Apr 15;69(12):1028-32. doi: 10.1016/0002-9149(92)90858-v.
To better define the natural history of supraventricular tachycardia (SVT) in young patients, age distribution of SVT mechanisms was examined in 137 infants, children and adolescents. Patients with a history of cardiac surgery or neuromuscular diseases were excluded. An electrophysiologic study was performed in each patient: transesophageal (110 patients) or transvenous (14 patients) or both (13 patients). Mechanisms were classified as SVT using accessory atrioventricular (AV) connection (SVT using accessory connection, including orthodromic and antidromic reciprocating tachycardia), primary atrial tachycardia (including chaotic, automatic and reentrant atrial tachycardia), and tachycardia due to reentry within the AV node. SVT using accessory connection occurred in 100 of 137 patients (73%) and was the most prevalent mechanism. Primary atrial tachycardia and reentry within the AV node were present in 19 of 137 (14%) and 18 of 137 (13%) patients, respectively. Using a multinomial logit model, relative probabilities for tachycardia mechanisms for 5 age groups--prenatal, less than 1, 1 to 5, 6 to 10 and greater than 10 years--were determined. Primary atrial tachycardia (11 to 16%) and SVT using accessory connection (58 to 84%) appeared throughout infancy, childhood and adolescence. On the other hand, tachycardia due to reentry within the AV node (0 to 31%) rarely appeared before age 2 years. Mechanisms of SVT appear to have age-dependent distributions. SVT using accessory connection is the most common mechanism in young patients. We speculate that the propensity to tachycardia due to reentry within the AV node occurs during postnatal development.
为了更好地明确年轻患者室上性心动过速（SVT）的自然病程，我们对137例婴儿、儿童及青少年的SVT机制的年龄分布情况进行了研究。排除有心脏手术史或神经肌肉疾病的患者。对每位患者均进行了电生理检查：经食管检查（110例患者）、经静脉检查（14例患者）或两者都进行（13例患者）。机制分类为使用房室（AV）旁道的SVT（使用旁道的SVT，包括顺向型和逆向型折返性心动过速）、原发性房性心动过速（包括紊乱性、自律性和折返性房性心动过速）以及房室结内折返性心动过速。137例患者中有100例（73%）发生使用旁道的SVT，这是最常见的机制。原发性房性心动过速和房室结内折返性心动过速分别见于137例患者中的19例（14%）和18例（13%）。使用多项logit模型，确定了5个年龄组——产前、小于1岁、1至5岁、6至10岁和大于10岁——心动过速机制的相对概率。原发性房性心动过速（11%至16%）和使用旁道的SVT（58%至84%）在婴儿期、儿童期和青少年期均有出现。另一方面，房室结内折返性心动过速（0至31%）在2岁前很少出现。SVT的机制似乎具有年龄依赖性分布。使用旁道的SVT是年轻患者中最常见的机制。我们推测，房室结内折返性心动过速的易患倾向发生在出生后的发育过程中。
