Nomura Yuichi, Seki Syunji, Hazeki Daisuke, Ueno Kentaro, Tanaka Yuji, Masuda Kiminori, Nishibatake Makoto, Yoshinaga Masao
Committee on the School-based ECG Screening Program of Kagoshima City Medical Association Kagoshima Japan.
Department of Pediatrics Kagoshima City Hospital Kagoshima Japan.
J Arrhythm. 2019 Dec 16;36(1):127-133. doi: 10.1002/joa3.12286. eCollection 2020 Feb.
We examined risk factors for development of ventricular tachycardia (VT) in pediatric patients with ventricular premature contractions (VPCs) and a structurally normal heart.
The subjects were 81 844 first graders and 88 244 seventh graders of Kagoshima City School-based cardiovascular screening (SCV-screening) between 2001 and 2015. We retrospectively reviewed the clinical data of students who were diagnosed as having VPC.
Ventricular premature contractions were observed in 134 first graders (0.16%) and 270 seventh graders (0.31%). On the screening electrocardiograms (ECGs), 43 patients (11%) showed bi-/trigemini, three patients (0.7%) showed a couplet, and one patient showed VT. We obtained 166 patients' follow-up information and evaluated 59 patients (36%) as improved, 97 patients (58%) as no change, and 10 patients (6%) as worsened (couplets, five; triplets, two; VT, three). We assumed that these worsened patients have risk factors for development of VT. Comparing the findings of SCV-screening ECGs of risk patients with the others, a significant difference was observed only in the number of VPCs (per 10 seconds) (mean ± SD; 4.3 ± 2.6 vs 1.8 ± 1.4, < .0001). A logistic regression analysis revealed that the number of VPCs was significant ( < .001, odds ratio; 2.01, 95% confidence intervals; 1.46-2.93). Receiver operating characteristics analysis showed an adequate cut-off number of three VPCs for the risk, the sensitivity was 89% and the specificity was 77%.
Of the patients with VPC and a structurally normal heart, a few patients developed VT. Careful observation is important in patients who had three or more VPCs on SCV-screening ECG.
我们研究了患有室性早搏（VPC）且心脏结构正常的儿科患者发生室性心动过速（VT）的危险因素。
研究对象为2001年至2015年间鹿儿岛市学校心血管筛查（SCV筛查）中的81844名一年级学生和88244名七年级学生。我们回顾性分析了被诊断为患有VPC的学生的临床资料。
在134名一年级学生（0.16%）和270名七年级学生（0.31%）中观察到室性早搏。在筛查心电图（ECG）上，43例患者（11%）表现为二联律/三联律，3例患者（0.7%）表现为成对早搏，1例患者表现为室性心动过速。我们获得了166例患者的随访信息，其中59例患者（36%）评估为改善，97例患者（58%）评估为无变化，10例患者（6%）评估为恶化（成对早搏5例；三联律2例；室性心动过速3例）。我们假设这些病情恶化的患者具有发生室性心动过速的危险因素。将风险患者的SCV筛查心电图结果与其他患者进行比较，仅在室性早搏数量（每10秒）上观察到显著差异（平均值±标准差；4.3±2.6对1.8±1.4，P<0.0001）。逻辑回归分析显示室性早搏数量具有显著性（P<0.001，比值比；2.01，95%置信区间；1.46 - 2.93）。受试者工作特征分析显示，室性早搏风险的合适截断值为3次，敏感性为89%，特异性为77%。
在患有室性早搏且心脏结构正常的患者中，少数患者发生了室性心动过速。对于SCV筛查心电图上有三次或更多室性早搏的患者，仔细观察很重要。
