Lucile Packard Children's Hospital-Stanford University, Pediatric Cardiology, Pediatric Electrophysiology-Department of Pediatrics, Palo Alto, California.
Lucile Packard Children's Hospital-Stanford University, Pediatric Cardiology, Pediatric Electrophysiology-Department of Pediatrics, Palo Alto, California; Lucille Packard Children's Hospital-Stanford University, Stanford Center for Clinical & Translational Research & Education and Stanford Child Health Research Institute Spectrum Child Health, Division of Pediatric Cardiology, Palo Alto, California.
Heart Rhythm. 2015 Jul;12(7):1541-7. doi: 10.1016/j.hrthm.2015.03.047. Epub 2015 Mar 28.
One of the basic electrophysiological principles of atrioventricular reciprocating tachycardia (AVRT) is that ventriculoatrial (VA) times during tachycardia are >70 ms. We hypothesized, however, that children may commonly have VA times <70 ms in AVRT.
This study sought to determine the incidence and characteristics associated with short-VA AVRT in children.
A retrospective single-center review of children with AVRT from 2000 to 2014 was performed. All patients ≤18 years of age with AVRT at electrophysiology study were included. Patients with persistent junctional reciprocating tachycardia, atrioventricular nodal reentry tachycardia, and tachycardia not unequivocally proven to be AVRT were excluded. VA time was defined as the time between earliest ventricular activation and earliest atrial activation in any lead and was confirmed by 2 electrophysiologists. Patients with VA times <70 ms (SHORT-VA) and those with standard VA times ≥70 ms (STD-VA) were compared. Logistic regression analysis identified characteristics of SHORT-VA patients.
A total of 495 patients with AVRT were included (mean age 11.7 ± 4.1 years). There were 265 patients (54%) with concealed accessory pathways (APs) and 230 (46%) with Wolff-Parkinson-White syndrome. AP location was left-sided in 301 patients (61%) and right-sided in 194 (39%). The mean VA time in AVRT was 100 ± 33 ms. A total of 63 patients (13%) had VA times <70 ms (SHORT-VA). The shortest VA time during AVRT was 50 ms. There was no difference in age, AV nodal block cycle, or body surface area between SHORT-VA and STD-VA patients, but SHORT-VA patients had lower weight (43 ± 17 vs 51 ± 23 kg, P = .02), lower AV nodal effective refractory period (AVNERP; 269 ± 50 vs 245 ± 52 ms, P < .01), and more left-sided APs (50 [79%] vs 251 [58%]; P < .01]. On multivariate logistic regression, factors associated with SHORT-VA included left-sided AP (odds ratio [OR] 5.79, confidence interval [95% CI] 2.21-15.1, P < .01), shorter AVNERP (OR 0.99, CI 0.98-0.99, P < .01), and lower weight (OR 0.97, CI 0.95-0.99, P < .01).
Children with AVRT can frequently have VA times <70 ms, with 50 ms being the shortest VA time. This finding debunks the classic electrophysiology principle that VA times in AVRT must be >70 ms. SHORT-VA AVRT was more common in children with left-sided APs.
房室折返性心动过速（AVRT）的基本电生理原理之一是心动过速时的房室（VA）时间>70ms。然而，我们假设儿童在 AVRT 中可能经常出现 VA 时间<70ms。
本研究旨在确定儿童短 VA AVRT 的发生率和相关特征。
对 2000 年至 2014 年期间行电生理检查的 AVRT 患儿进行回顾性单中心研究。所有≤18 岁的 AVRT 患儿均纳入研究。排除持续性结间折返性心动过速、房室结折返性心动过速和不能明确诊断为 AVRT 的心动过速。VA 时间定义为最早心室激活与任何导联最早心房激活之间的时间，并由 2 名电生理学家确认。VA 时间<70ms（短 VA）的患者与标准 VA 时间≥70ms（长 VA）的患者进行比较。逻辑回归分析确定短 VA 患者的特征。
共纳入 495 例 AVRT 患儿（平均年龄 11.7±4.1 岁）。其中隐匿性旁路（AP）265 例（54%），WPW 综合征 230 例（46%）。AP 位于左侧 301 例（61%），右侧 194 例（39%）。AVRT 时的平均 VA 时间为 100±33ms。63 例（13%）患者的 VA 时间<70ms（短 VA）。最短的 AVRT 时 VA 时间为 50ms。短 VA 和长 VA 患者的年龄、房室结阻滞周期和体表面积无差异，但短 VA 患者体重较轻（43±17kg vs 51±23kg，P=0.02），房室结有效不应期较短（269±50ms vs 245±52ms，P<0.01），左侧 AP 更多（50[79%]vs 251[58%]；P<0.01）。多变量逻辑回归分析显示，短 VA 与左侧 AP（比值比[OR]5.79，95%置信区间[CI]2.21-15.1，P<0.01）、较短的房室结有效不应期（OR 0.99，CI 0.98-0.99，P<0.01）和较低的体重（OR 0.97，CI 0.95-0.99，P<0.01）相关。
儿童 AVRT 时 VA 时间可<70ms，最短 VA 时间为 50ms。这一发现推翻了 AVRT 中 VA 时间必须>70ms 的经典电生理原理。左侧 AP 患儿更常见短 VA AVRT。
