Emmel M, Sreeram N, Schickendantz S, Brockmeier Konrad
Department of Pediatric Cardiology, University of Cologne, 50937 Cologne, Germany.
J Electrocardiol. 2006 Apr;39(2):188-93. doi: 10.1016/j.jelectrocard.2005.09.003. Epub 2005 Nov 9.
The 12-lead electrocardiogram demonstrates noninvasively many details concerning cardiac arrhythmias and their mechanism, but only for a limited period. A Holter system can record heart rhythm for a longer period, but shows 2 or 3 leads only. An ambulatory 12-lead Holter recording system combines the advantages of both. We report on our experience with the 12-lead Holter system in children.
Twenty-four patients (age range, 3-22 years) underwent one or more 12-lead Holter recordings. Twelve patients had suspected or documented tachyarrhythmia, and 12 patients had suspected or proven long QT syndrome (LQTS).
In the tachyarrhythmia group, 4 patients had supraventricular tachycardia and 7 ventricular tachycardia (VT). In the supraventricular tachycardia, group 1 patient had intra-atrial reentrant tachycardia with a single reentrant circuit, whereas another had multiple P-wave morphologies, suggesting multiple circuits. Two others had evidence for concealed atrioventricular accessory pathways. One patient had isolated supraventricular ectopy. In the VT group, 4 patients had uniform VT, and 3 patients had polymorphic VT. One patient with LQTS had macroscopic T-wave alternans. Two others showed intermittent extreme QT prolongation and T-wave notching during 12-lead Holter recording.
Patients with uniform VT underwent catheter ablation, guided in 2 instances by intracardiac pace mapping and comparison with the 12-lead Holter QRS morphology. All reentrant supraventricular arrhythmias with single P-wave morphology were ablated. One patient with intra-atrial reentrant tachycardia and multiple circuits received an antitachycardia pacemaker. In the LQTS group, the neonate with T-wave alternans received mexiletine in addition to beta-blocker therapy.
In individual patients, the 12-lead Holter system provides important additional information about the arrhythmia and helps to plan appropriate therapy. Intermittent T-wave morphology changes can be diagnosed using 12-lead Holter recordings in patients with LQTS, allowing dynamic T-wave changes to be monitored. In specific cases, this may help identify patients with LQTS and also influence pharmacological therapy.
12导联心电图能无创地显示有关心律失常及其机制的许多细节，但仅能在有限时间内进行。动态心电图系统可长时间记录心律，但仅显示2或3个导联。动态12导联心电图记录系统兼具两者的优点。我们报告了在儿童中使用12导联动态心电图系统的经验。
24例患者（年龄范围3至22岁）接受了一次或多次12导联动态心电图记录。12例患者有疑似或确诊的快速性心律失常，12例患者有疑似或确诊的长QT综合征（LQTS）。
在快速性心律失常组中，4例患者为室上性心动过速，7例为室性心动过速（VT）。在室上性心动过速组中，1例患者为单折返环房内折返性心动过速，而另1例有多种P波形态，提示多折返环。另外2例有隐匿性房室旁路证据。1例患者有孤立性室上性早搏。在VT组中，4例患者为单形性VT，3例为多形性VT。1例LQTS患者有明显的T波交替。另外2例在12导联动态心电图记录期间显示间歇性QT极度延长和T波切迹。
单形性VT患者接受了导管消融治疗，2例在心脏内起搏标测并与12导联动态心电图QRS形态比较的指导下进行。所有单P波形态的折返性室上性心律失常均被消融。1例房内折返性心动过速伴多折返环的患者接受了抗心动过速起搏器治疗。在LQTS组中，有T波交替的新生儿除接受β受体阻滞剂治疗外还接受了美西律治疗。
对于个体患者，12导联动态心电图系统可提供有关心律失常的重要补充信息，并有助于制定适当的治疗方案。使用12导联动态心电图记录可诊断LQTS患者的间歇性T波形态变化，从而监测动态T波变化。在特定情况下，这可能有助于识别LQTS患者并影响药物治疗。
