Tripathi Avnish, Black George B, Park Yong-Moon Mark, Jerrell Jeanette M
Department Medicine, University of Mississippi School of Medicine, 2500 N State St, Jackson, MS, 39216, USA.
Pediatr Cardiol. 2014 Feb;35(2):368-73. doi: 10.1007/s00246-013-0784-3. Epub 2013 Sep 1.
In patients with congenital heart disease (CHD), the association between supraventricular tachycardia (SVT), type of pathophysiology, and therapeutic interventions in a population-based cohort warrants further examination. A retrospective, longitudinal 15-year data set (1996-2010) was analyzed. Inclusion criteria included age ≤17 years, enrolled in South Carolina State Medicaid, and diagnosed as having one or more CHDs as well as SVT. SVT was diagnosed in 6.5 % of CHD patients (N = 1,169) during the 15-year epoch investigated. SVT was less likely to occur in African-American (hazard ratio [HR] = 0.76) or male patients (HR = 0.88), but it was significantly more likely to occur in patients age ≤12 months or in adolescents ≥13 years in those undergoing multiple surgeries/medical interventions for their CHD (HR = 1.14), those receiving antiarrhythmic/diuretic/preload-/afterload-reducing medications (HR = 5.46), and those with severe/cyanotic CHDs (HR = 1.52) or chromosomal abnormalities (HR = 1.64). Children who had an atrial septal defect secundum (adjusted odds ratio [aOR] = 3.03) and those treated with diuretic or antiarrhythmic medication (aOR = 1.80) were significantly more likely to undergo SVT ablation, whereas those with late-onset pulmonary hypertension (ages 6-12 years old) were significantly less likely to undergo SVT ablation. SVT recurred in only 14 of 166 patients who underwent SVT ablation. Multiple medical interventions at an early age may increase the risk of SVT occurrence in young CHD patients regardless of the severity/complexity of the CHD.
在先天性心脏病（CHD）患者中，基于人群队列的室上性心动过速（SVT）、病理生理学类型与治疗干预之间的关联值得进一步研究。分析了一个回顾性的、长达15年（1996 - 2010年）的纵向数据集。纳入标准包括年龄≤17岁、参加南卡罗来纳州医疗补助计划且被诊断患有一种或多种CHD以及SVT。在所研究的15年期间，6.5%的CHD患者（N = 1169）被诊断为SVT。SVT在非裔美国人（风险比[HR]=0.76）或男性患者（HR = 0.88）中发生的可能性较小，但在年龄≤12个月的患者或因CHD接受多次手术/医疗干预的≥13岁青少年中（HR = 1.14）、接受抗心律失常/利尿剂/降低前负荷/后负荷药物治疗的患者中（HR = 5.46）以及患有严重/青紫型CHD（HR = 1.52）或染色体异常（HR = 1.64）的患者中发生的可能性显著更高。患有继发孔型房间隔缺损的儿童（调整优势比[aOR]=3.03）以及接受利尿剂或抗心律失常药物治疗的儿童（aOR = 1.80）进行SVT消融的可能性显著更高，而患有迟发性肺动脉高压（6 - 12岁）的患者进行SVT消融的可能性显著更低。在166例接受SVT消融的患者中，只有14例出现SVT复发。无论CHD的严重程度/复杂性如何，早年进行多次医疗干预可能会增加年轻CHD患者发生SVT的风险。
