[144例儿童异位房性心动过速的临床病程及治疗]

Ge Haiyan, Li Xiaomei, Zhang Yan, Liu Haiju, Jiang He

Zhonghua Er Ke Za Zhi. 2015 Mar;53(3):214-9.

OBJECTIVE

Ectopic atrial tachycardia (EAT) is a common type of supraventricular tachycardia in pediatric population, and it can be resistant to antiarrhythmic drugs and lead to tachycardia induced cardiomyopathy (TIC) if not properly managed. This study assessed the clinical course and response to treatment of EAT in children.

METHOD

A retrospective review included 144 children at the First Hospital of Tsinghua University diagnosed with EAT from January 2009 to April 2014. The clinical detailed history, 12 lead ECG, 24-h Holter recording, echocardiography, response to therapy and follow-up were analyzed.

RESULT

The onset of EAT occurred at any age with a distribution with positive skewness, 57 children ≤1 years, 22 children > 1 - 3 years, 25 children > 3 - 6 years and 40 children ≥ 6 years of age. The percentages of the three tachycardia types were 36. 1% (n = 52) for incessant EAT, 52. 8% (n = 76) for paroxysmal EAT and 11. 1% (n = 16) for sporadic EAT, respectively. There were 115 patients received drug therapy in our hospital and in 72 cases the EAT was completely controlled. Antiarrhythmic therapy had been discontinued in 35 children with complete control. Normal sinus rhythm was observed by telemetry or Holter within 4 to 90 days and the mean duration of medical therapy was 310 days (range 15 to 608 days) in these children. The combination of sotalol and propafenone showed better effectiveness for control of children with EAT (54%, 41/76), compared with single sotalol (36%, 24/66) and the combination of amiodarone and metoprolol (30%, 7/23) (χ2 = 6. 296, P = 0. 043). Tachycardia type was able to predict the response to antiarrhythmic drugs for children with EAT, sporadic tachycardia had best control rate on pharmacological therapy compared with paroxysmal tachycardia and incessant tachycardia (94% (15/16) vs. 67% (42/63) vs. 42% (15/36), χ2 = 17. 925, P = 0. 000) . Acute success of radiofrequency ablation (RFA) in children who showed poor response to antiarrhythmic drugs was achieved in 45 of 49 (92%), ultimate success was achieved in 33 of 49 (67%). The incidence of TIC secondary to EAT was 18. 1% (n =26), and left ventricular ejection-fraction (LVEF) returned to normal in 23 children after successful control of EAT ((61 ± 4) % vs. (43 ± 5) %, t = - 10. 036, P = 0. 000). Side effects including abnormal thyroid function (in 3) and abnormal liver function (in 1) occurred in 4 (17%) of 23 children who received amiodarone and disappeared when amiodarone was discontinued.

CONCLUSION

EAT in children predominantly occurred in young infants and children. Incessant EAT comprised a great percentage. The combination of sotalol and propafenone provided the best results for control of children with EAT. RFA should be considered as a preferred treatment for older children who displayed poor response to medical therapy.

目的

异位房性心动过速（EAT）是儿科人群中常见的室上性心动过速类型，若治疗不当，其对抗心律失常药物耐药，并可导致心动过速性心肌病（TIC）。本研究评估了儿童EAT的临床病程及治疗反应。

方法

一项回顾性研究纳入了2009年1月至2014年4月在清华大学第一附属医院诊断为EAT的144例儿童。分析了临床详细病史、12导联心电图、24小时动态心电图记录、超声心动图、治疗反应及随访情况。

结果

EAT可发生于任何年龄，呈正偏态分布，≤1岁的儿童有57例，>1至3岁的儿童有22例，>3至6岁的儿童有25例，≥6岁的儿童有40例。三种心动过速类型的比例分别为持续性EAT 36.1%（n = 52）、阵发性EAT 52.8%（n = 76）和散发性EAT 11.1%（n = 16）。我院共有115例患者接受了药物治疗，其中72例EAT得到完全控制。35例完全控制的儿童已停用抗心律失常治疗。这些儿童通过遥测或动态心电图在4至90天内观察到正常窦性心律，药物治疗的平均持续时间为310天（范围15至608天）。与单用索他洛尔（36%，24/66）以及胺碘酮与美托洛尔联合使用（30%，7/23）相比，索他洛尔与普罗帕酮联合使用对控制儿童EAT显示出更好的有效性（54%，41/76）（χ2 = 6.296，P = 0.043）。心动过速类型能够预测EAT儿童对抗心律失常药物的反应，与阵发性心动过速和持续性心动过速相比，散发性心动过速在药物治疗上的控制率最佳（94%（15/16）对67%（42/63）对42%（15/36），χ2 = 17.925，P = 0.000）。49例对抗心律失常药物反应不佳的儿童中，45例（92%）射频消融（RFA）取得急性成功，49例中的33例（67%）取得最终成功。EAT继发TIC的发生率为18.1%（n = 26），EAT成功控制后，23例儿童的左心室射血分数（LVEF）恢复正常（（61±4）%对（43±5）%，t = -10.036，P = 0.000）。23例接受胺碘酮治疗的儿童中有4例（17%）出现副作用，包括甲状腺功能异常（3例）和肝功能异常（1例），停用胺碘酮后副作用消失。