Nagashima M, Nakashima T, Asai T, Matsushima M, Ogawa A, Ohsuga A, Kaneko T, Yazaki T, Okajima M
Jpn Heart J. 1987 May;28(3):323-32. doi: 10.1536/ihj.28.323.
Ambulatory electrocardiographic monitoring was performed in 18 children with a congenital complete heart block (CCHB). They had no cardiac structural anomalies. These patients could be divided into 3 groups according to the pattern of fluctuations in beat-to-beat ventricular rates. Type 1 patients showed rapid and transient fluctuations and demonstrated a high correlation between atrial and ventricular rates. Type 3 patients showed a constant ventricular rate and little variation through the 24 hour period and there was no appreciable correlation between atrial and ventricular rates. Twelve of 18 patients had additional arrhythmias. A few sporadic ventricular premature contractions (VPCs) were found in 9 patients, and bigeminy of VPCs or ventricular tachycardias were seen in 2 patients during exercise. Frequent and sudden prolongation of RR intervals was found during sleep in 3 patients. The longest intervals of ventricular asystoles were 7.2, 3.2 and 3.2 sec, respectively. The mechanism of this phenomenon appeared to be not only an exit block, but also arrest or a lack of automaticity of a subsidiary pacemaker. One of these patients developed frequent Stokes-Adams attacks. Type 3 patients with sudden prolongation of RR intervals and/or frequent ventricular arrhythmias should be under careful observation. Ambulatory electrocardiographic monitoring is recommended for children with CCHB for evaluation of potential risk factors for Stokes-Adams attacks.
对18例先天性完全性心脏传导阻滞（CCHB）患儿进行了动态心电图监测。他们没有心脏结构异常。根据逐搏心室率的波动模式，这些患者可分为3组。1型患者表现为快速且短暂的波动，心房率和心室率之间显示出高度相关性。3型患者心室率恒定，在24小时内变化很小，心房率和心室率之间没有明显相关性。18例患者中有12例有额外的心律失常。9例患者发现少数散发性室性早搏（VPC），2例患者在运动期间出现室性早搏二联律或室性心动过速。3例患者在睡眠期间发现RR间期频繁且突然延长。心室停搏的最长间期分别为7.2、3.2和3.2秒。这种现象的机制似乎不仅是传出阻滞，也是辅助起搏器的停搏或自律性缺乏。其中1例患者出现频繁的斯托克斯-亚当斯发作。RR间期突然延长和/或频繁室性心律失常的3型患者应仔细观察。建议对CCHB患儿进行动态心电图监测，以评估斯托克斯-亚当斯发作的潜在危险因素。
