Hammerer I
Padiatr Padol. 1979;14(4):393-403.
Disturbances of heart rhythm, observed during 700 heart catheterizations in infants and children, are discussed. Paroxysmal supraventricular tachycardia has been observed in 25 investigations (3,6%), sinus bradycardia in 18 (2,6%), junctional rhythm in 10 (1,4%), second degree AV-block in 9 (1,3%), ventricular fibrillation in 8 (1,1%), sinus tachycardia in 7 (1%), complete block in 7 (1%), asystole and atrial flutter in 2 (0,3%) each, and ventricular tachycardia in 1 (0,15%). Supraventricular tachycardia occurred equally in all ages without preference of a special malformation. The two patients with WPW-syndrome, however, showed this disorder in each of three catheterizations. Propranolol and verapamil succeeded in terminating the attacks. Junctional rhythm and sinus tachycardia presented equal behavior and benignity. Sinus bradycardia, second and third degree AV-block, and especially ventricular fibrillation occurred mostly in neonates and infants, many of them cyanotic and suffering from complex malformations and therefore needing multiple catheter manipulations. Bradycardia was in two, asystole in one of the very sick neonates associated with subsequent death within 24 hours. Once asystole resulted in immediate death after pulmonary angiography in a child with severe pulmonary hypertension. Ventricular fibrillation could be terminated promptly by DC countershock in all patients, but three of the children died subsequently. Complete block occurred only in children with systemic right ventricular pressure, 4 of the 7 patients having pulmonary hypertension, too. In two instances the block subsided spontaneously, the rest could successfully be treated with orciprenaline (Alupent R). Life threatening arrhythmias became less frequent as a consequence of earlier investigation, if severe heart disease was suspected, and by closer control of cyanosis, acidosis and temperature before, during, and after catheterization.
本文讨论了在700例婴幼儿心脏导管插入术中观察到的心律失常情况。阵发性室上性心动过速在25例检查中被观察到（3.6%），窦性心动过缓18例（2.6%），交界性心律10例（1.4%），二度房室传导阻滞9例（1.3%），心室颤动8例（1.1%），窦性心动过速7例（1%），完全性传导阻滞7例（1%），心搏停止和心房扑动各2例（0.3%），室性心动过速1例（0.15%）。室上性心动过速在各年龄段出现的几率相同，无特殊畸形倾向。然而，两名患有预激综合征的患者在三次导管插入术中均出现了这种病症。普萘洛尔和维拉帕米成功终止了发作。交界性心律和窦性心动过速表现出相同的特性和良性。窦性心动过缓、二度和三度房室传导阻滞，尤其是心室颤动大多发生在新生儿和婴儿中，其中许多患有青紫症且伴有复杂畸形，因此需要多次导管操作。两名新生儿出现心动过缓，一名病情严重的新生儿出现心搏停止，随后在24小时内死亡。一名患有严重肺动脉高压的儿童在肺血管造影后因心搏停止立即死亡。所有患者的心室颤动均可通过直流电除颤迅速终止，但其中三名儿童随后死亡。完全性传导阻滞仅发生在系统性右心室压力的儿童中，7例患者中有4例也患有肺动脉高压。在两例中，传导阻滞自行消退，其余患者可用奥西那林（Alupent R）成功治疗。由于早期进行检查（如果怀疑患有严重心脏病）以及在导管插入术前、术中和术后密切控制青紫症、酸中毒和体温，危及生命的心律失常的发生率有所降低。
