Tunca Sahin Gulhan, Ozturk Erkut, Kasar Taner, Guzeltas Alper, Ergul Yakup
Department of Pediatric Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center and Research Hospital, Istanbul Saglik Bilimleri University, Istanbul, Turkey.
Pediatr Int. 2018 Feb;60(2):115-121. doi: 10.1111/ped.13445.
The aim of this study was to evaluate the results of non-operational sustained tachyarrhythmia in patients <1 year of age at the present center.
Between November 2010 and November 2016, the demographic characteristics, type and localization of the tachyarrhythmia, echocardiographic findings, and medical and/or ablation therapy for patients <1 year of age with sustained tachyarrhythmia were evaluated.
Of 99 patients, 91 had sustained supraventricular tachycardia, and eight had sustained ventricular tachycardia. The median age was 30 days (range, 1-350 days), and the median weight was 4.2 kg (range, 2-13 kg). The common symptoms were palpitation and restlessness (n = 49, 49.5%), or the tachycardia was detected during routine inspection (n = 25, 25.3%) or fetal echocardiography (n = 11, 11.1%). Nineteen individuals (19%) had left ventricular (LV) dysfunction on first echocardiography. Twenty individuals had congenital heart disease. Common diagnoses were Wolff-Parkinson-White syndrome (n = 27), focal atrial tachycardia (n = 10), permanent junctional reciprocating tachycardia(n = 6), and atrial flutter (n = 6). Seventeen patients underwent medical therapy combined with cardioversion. The most commonly used abortive and acute therapy agents were adenosine, esmolol, and amiodarone. The most common combination therapy was propranolol and amiodarone, followed by a propranolol and propafenone combination. Nine individuals were treated with catheter ablation due to either resistance to medical therapy or LV dysfunction.
Tachyarrhythmias in children <1 year of age are mostly caused by accessory pathways and require multidrug therapy. Catheter ablation is an effective alternative therapy in the case of resistance to medical therapy and/or LV dysfunction.
本研究旨在评估本中心1岁以下患者非手术性持续性快速心律失常的治疗结果。
对2010年11月至2016年11月期间1岁以下持续性快速心律失常患者的人口统计学特征、快速心律失常的类型和定位、超声心动图检查结果以及药物和/或消融治疗进行评估。
99例患者中，91例为持续性室上性心动过速，8例为持续性室性心动过速。中位年龄为30天（范围1 - 350天），中位体重为4.2千克（范围2 - 13千克）。常见症状为心悸和烦躁不安（n = 49，49.5%），或在常规检查（n = 25，25.3%）或胎儿超声心动图检查（n = 11，11.1%）时发现心动过速。19例患者（19%）首次超声心动图检查显示左心室（LV）功能障碍。20例患者患有先天性心脏病。常见诊断为预激综合征（n = 27）、局灶性房性心动过速（n = 10）、永久性交界性反复性心动过速（n = 6）和心房扑动（n = 6）。17例患者接受了药物治疗联合心脏复律。最常用的终止发作和急性治疗药物是腺苷、艾司洛尔和胺碘酮。最常见的联合治疗是普萘洛尔和胺碘酮，其次是普萘洛尔和普罗帕酮联合。9例患者因药物治疗无效或LV功能障碍接受了导管消融治疗。
1岁以下儿童的快速心律失常大多由旁路引起，需要多种药物治疗。对于药物治疗无效和/或LV功能障碍的情况，导管消融是一种有效的替代治疗方法。
