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小儿扩张型心肌病/左心室心肌致密化不全/心内膜弹力纤维增生症中心律失常与预后的相关性

Correlation Between Arrhythmia and the Prognosis in Children With EFE/LVNC/DCM.

作者信息

Wang Hong, Chu Yan-Qiu, Yu Xian-Yi, Chen Rui, Xing Yan-Lin, Yu Xue-Xin, Wang Ce, Sun Le, Xu Yun-Ming, Li Xue-Mei, Cui Xiao-Zhe

机构信息

Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China.

出版信息

Front Pediatr. 2020 Jun 10;8:280. doi: 10.3389/fped.2020.00280. eCollection 2020.

Abstract

To explore the correlation between different phenotypes of arrhythmia and the prognosis in children with EFE/LVNC/DCM. A total of 167 children with cardiomyopathy diagnosed and treated in Shengjing Hospital between January 2010 and May 2019 were evaluated. After patient screening, 31 patients with endomyocardial fibroelastosis (EFE), left ventricular non-compaction, or dilated cardiomyopathy with significant arrhythmias were selected. In addition, 42 children with primary EFE were selected to evaluate the prognosis with or without arrhythmia. Follow-up was undertaken 0, 1, 3, 6, 9, and 12 months after treatment. We revealed the outcomes for five types of cardiomyopathy: EFE patients with Wolff-Parkinson-White syndrome B and supraventricular tachycardia, intraventricular block and complete left bundle branch block recovered slower than EFE patients with atrial flutter and atrial fibrillation, even slower than EFE with ventricular tachycardia. The average recovering time for LVEF and LVED in EFE patients without arrythmia was 10 months after diagnosis, while 76.9% (3/13 cases) of those with significant arrythmia hadn't recovered until 24 months after diagnosis. Three of patients died at 6, 7, and 6 and half years after diagnosis. The long-term prognosis in children with cardiomyopathy is associated with the type of arrhythmia and time of intervention. The prognosis of EFE patients with arrhythmia is worse than EFE patients without arrhythmia. Patients with Wolff-Parkinson-White syndrome B, especially a significantly widen QRS complex, carry a poor prognosis if radiofrequency ablation is not undertaken. CLBBB patients have similar poor prognosis if proper pacemaker is not implanted timely.

摘要

探讨小儿心内膜弹力纤维增生症(EFE)/左心室心肌致密化不全(LVNC)/扩张型心肌病(DCM)不同心律失常表型与预后的相关性。对2010年1月至2019年5月在盛京医院诊断并治疗的167例心肌病患儿进行评估。经过患者筛选,选取31例患有心内膜弹力纤维增生症、左心室心肌致密化不全或伴有显著心律失常的扩张型心肌病患者。此外,选取42例原发性心内膜弹力纤维增生症患儿评估有无心律失常时的预后情况。治疗后0、1、3、6、9和12个月进行随访。我们揭示了五种类型心肌病的结果:患有B型预激综合征和室上性心动过速、室内传导阻滞和完全性左束支传导阻滞的EFE患者恢复慢于患有心房扑动和心房颤动的EFE患者,甚至慢于患有室性心动过速的EFE患者。无心律失常的EFE患者左心室射血分数(LVEF)和左心室舒张末期内径(LVED)的平均恢复时间在诊断后为10个月,而有显著心律失常的患者中76.9%(13例中的3例)直到诊断后24个月仍未恢复。3例患者分别在诊断后6年、7年和6年半死亡。心肌病患儿的长期预后与心律失常类型和干预时间有关。有心律失常的EFE患者预后比无心律失常的EFE患者差。患有B型预激综合征的患者,尤其是QRS波群显著增宽者,若不进行射频消融,预后不良。完全性左束支传导阻滞患者若不及时植入合适的起搏器,预后同样不良。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9ee6/7297920/35b1cd8806f4/fped-08-00280-g0001.jpg

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