Bromberg B I, Lindsay B D, Cain M E, Cox J L
Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
J Am Coll Cardiol. 1996 Mar 1;27(3):690-5. doi: 10.1016/0735-1097(95)00519-6.
This study sought to determine whether the clinical and electrophysiologic criteria developed in adults also identify children with Wolff-Parkinson-White syndrome at risk for sudden death.
In adults with Wolff-Parkinson-White syndrome, a shortest RR interval <220 ms during atrial fibrillation is a sensitive marker for sudden death. However, because reliance on the shortest RR interval has a low positive predictive value, the clinical history has assumed a pivotal role in assessing risk. This approach has not been evaluated in children.
We retrospectively evaluated 60 children </= 18 years old who underwent comprehensive electrophysiologic evaluation between 1979 and 1989 before undergoing operation for Wolff-Parkinson-White syndrome. Clinical and electrophysiologic data were analyzed after patients had been grouped by their clinical presentation: high risk (cardiac arrest), intermediate risk (syncope or atrial fibrillation) or low risk (orthodromic reciprocating tachycardia alone).
Ten children had a clinical cardiac arrest (high risk); only one had a prior history of syncope or atrial fibrillation. Compared with the intermediate (n = 19) and low risk groups (n = 31), there were no differences in age ([mean +/- SD] 14.8 +/- 0.6 vs. 14.7 +/- 0.6 vs. 14.5 +/- 1.7 years), duration of symptoms (1.9 +/- 0.5 vs. 4.1 +/- 1.1 vs. 5.2 +/- .08 years), incidence of congenital heart disease (30% vs 26% vs 32%), presence of multiple pathways (20% vs 16% vs 16%) or accessory pathway location. A shortest pre-excited RR interval <220 ms was found in 7 of 7 high risk patients (sensitivity 100%), 14 of 19 intermediate risk patients and 11 of 31 low risk patients (prevalence 35%).
Cardiac arrest was the only distinguishing clinical feature between high and low risk groups and the first manifestation in 80% of the children of an accessory pathway that can precipitate a life-threatening arrhythmia. In this series, the largest reported to date of children with Wolff-Parkinson-White syndrome having a cardiac arrest, a shortest pre-excited RR interval <220 ms was more sensitive than clinical history for identifying those at risk for sudden death.
本研究旨在确定成人制定的临床和电生理标准是否也能识别出有猝死风险的 Wolff-Parkinson-White 综合征患儿。
在 Wolff-Parkinson-White 综合征成人患者中，房颤时最短 RR 间期<220 ms 是猝死的敏感标志物。然而，由于依赖最短 RR 间期的阳性预测值较低，临床病史在评估风险中起关键作用。这种方法尚未在儿童中进行评估。
我们回顾性评估了 60 名年龄≤18 岁的儿童，他们在 1979 年至 1989 年间因 Wolff-Parkinson-White 综合征接受手术前接受了全面的电生理评估。根据临床表现将患者分组后分析临床和电生理数据：高危（心脏骤停）、中危（晕厥或房颤）或低危（仅正向折返性心动过速）。
10 名儿童发生临床心脏骤停（高危）；只有 1 名有晕厥或房颤病史。与中危组（n = 19）和低危组（n = 31）相比，年龄（[均值±标准差]14.8±0.6 岁 vs. 14.7±0.6 岁 vs. 14.5±1.7 岁）、症状持续时间（1.9±0.5 年 vs. 4.1±1.1 年 vs. 5.2±0.08 年）、先天性心脏病发生率（30% vs 26% vs 32%）、多径路存在情况（20% vs 16% vs 16%）或旁路位置无差异。7 名高危患者中有 7 名（敏感性 100%）、19 名中危患者中有 14 名以及 31 名低危患者中有 11 名的最短预激 RR 间期<220 ms（患病率 35%）。
心脏骤停是高危和低危组之间唯一的区别性临床特征，并且是 80%能引发危及生命心律失常的旁路患儿的首发表现。在这个迄今为止报道的最大系列的 Wolff-Parkinson-White 综合征合并心脏骤停的儿童中，最短预激 RR 间期<220 ms 在识别猝死风险方面比临床病史更敏感。
