儿童和年轻成人隐匿性心肌炎消退后室性心律失常的持续存在。

Persistence of ventricular arrhythmia after resolution of occult myocarditis in children and young adults.

作者信息

Friedman R A, Kearney D L, Moak J P, Fenrich A L, Perry J C

机构信息

Section of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston 77030.

出版信息

J Am Coll Cardiol. 1994 Sep;24(3):780-3. doi: 10.1016/0735-1097(94)90029-9.

DOI:10.1016/0735-1097(94)90029-9

PMID:8077553

Abstract

OBJECTIVES

We sought to examine whether resolution of occult myocarditis in children with associated ventricular arrhythmia correlated with the presence of arrhythmia at late follow-up.

BACKGROUND

Complex ventricular arrhythmias have been documented in children with myocarditis. Therapy is aimed at controlling the arrhythmia and any associated ventricular dysfunction. However, no reported studies have documented whether resolution of myocarditis in children is associated with resolution of the associated arrhythmias.

METHODS

We performed a retrospective analysis of 12 patients (mean age 12 years) with myocarditis. Ambulatory electrocardiographic (Holter) monitors were reviewed for ventricular arrhythmias at presentation and follow-up. Patients were assigned to Group I if they received corticosteroids in addition to any antiarrhythmic agents and to Group II if they did not receive steroids. Follow-up endomyocardial biopsy was performed in some patients, and results were analyzed in relation to the presence of arrhythmias at follow-up.

RESULTS

Eleven patients had ventricular tachycardia, and one had multiform couplets. Corticosteroids were given to seven patients (Group I). Follow-up biopsy was performed in seven patients (six received steroids), with resolution of inflammation in all; four of the seven still had ventricular arrhythmias but with improved control. Of the five patients without follow-up biopsy, three had persistent arrhythmia. Absence of inflammation at follow-up biopsy did not correlate with loss of ventricular arrhythmias, and there was no difference between Group I and II patients with respect to resolution of arrhythmia (Fisher exact test, p = 0.70, power 11%).

CONCLUSIONS

Complex ventricular arrhythmias persist after apparent resolution of occult myocarditis in children. Although these arrhythmias are easier to control after such resolution, the patients may require long-term antiarrhythmic therapy.

摘要

目的

我们试图研究伴有室性心律失常的儿童隐匿性心肌炎的消退是否与后期随访时心律失常的存在相关。

背景

心肌炎患儿中已记录到复杂室性心律失常。治疗旨在控制心律失常及任何相关的心室功能障碍。然而，尚无报道研究记录儿童心肌炎的消退是否与相关心律失常的消退有关。

方法

我们对12例心肌炎患儿（平均年龄12岁）进行了回顾性分析。回顾动态心电图（Holter）监测结果，观察患儿就诊时及随访时的室性心律失常情况。如果患儿除接受任何抗心律失常药物治疗外还接受了皮质类固醇治疗，则归入第一组；如果未接受类固醇治疗，则归入第二组。部分患者进行了随访心内膜活检，并分析活检结果与随访时心律失常存在情况的关系。

结果

11例患者出现室性心动过速，1例出现多形性成对室性早搏。7例患者（第一组）接受了皮质类固醇治疗。7例患者（6例接受了类固醇治疗）进行了随访活检，所有患者炎症均消退；7例中有4例仍有室性心律失常，但控制情况有所改善。5例未进行随访活检的患者中，3例仍有持续性心律失常。随访活检时无炎症与室性心律失常消失无关，且第一组和第二组患者在心律失常消退方面无差异（Fisher精确检验，p = 0.70，检验效能11%）。