Sánchez Fernández-Bernal C, Benito Bartolomé F
Unidad de Arritmias, Hospital Infantil La Paz, Madrid.
Rev Esp Cardiol. 1997 Sep;50(9):643-9. doi: 10.1016/s0300-8932(97)73276-7.
The so called tachycardia-induced cardiomyopathy may develop as a complication of persistent abnormal high rates. It is especially common in patients who have either a permanent form of junctional reciprocating tachycardia or an ectopic atrial tachycardia. Radiofrequency catheter ablation has become established as an effective and safe treatment to eliminate both arrhythmias.
Four children aged from 3 months to 8 years, who had incessant tachyarrhythmias and left ventricular dysfunction (shortening fraction of mean +/- SD, 21.7 +/- 1.2%) underwent radiofrequency catheter ablation. The youngest patient had permanent junctional reciprocating tachycardia caused by a left posteroseptal pathway. She was presented with severe heart failure that did not improve with digoxin and amiodarone. The other patients had palpitations and exercise intolerance. Two of them had an ectopic atrial tachycardia caused by a single atrial focus localized in the left atrial appendage apex and the orifice of the right atrial appendage respectively. The other patient had the permanent form of junctional reciprocating tachycardia caused by a right posteroseptal pathway. All four patients underwent one successful ablation. The average procedure mean time was 3.7 hours with an fluoroscopy time of 44 minutes. There were no complications. Subsequently shortening fraction improved progressively. After a mean follow-up of 21.7 months all patients are asymptomatic without medical treatment.
Radiofrequency catheter ablation is the therapy of choice in children with either the permanent form of junctional reciprocating tachycardia or ectopic atrial tachycardia refractory to medical treatment. The tachycardia-induced cardiomyopathy is reversible after the elimination of the arrhythmia. The presence of tachycardia-induced cardiomyopathy is an indication for radiofrequency ablation even in small infants.
所谓的心动过速性心肌病可能作为持续性异常高心率的并发症而发生。它在患有永久性交界性折返性心动过速或异位房性心动过速的患者中尤为常见。射频导管消融已成为消除这两种心律失常的有效且安全的治疗方法。
4名年龄在3个月至8岁之间、患有持续性快速心律失常和左心室功能障碍（平均缩短分数±标准差，21.7±1.2%）的儿童接受了射频导管消融。最年幼的患者患有由左后间隔途径引起的永久性交界性折返性心动过速。她出现严重心力衰竭，使用地高辛和胺碘酮治疗后无改善。其他患者有心悸和运动不耐受。其中2名患者分别患有由位于左心耳尖和右心耳口的单个心房灶引起的异位房性心动过速。另一名患者患有由右后间隔途径引起的永久性交界性折返性心动过速。所有4名患者均成功进行了一次消融。平均手术时间为3.7小时，透视时间为44分钟。无并发症发生。随后缩短分数逐渐改善。平均随访21.7个月后，所有患者未经药物治疗均无症状。
对于患有永久性交界性折返性心动过速或药物治疗无效的异位房性心动过速的儿童，射频导管消融是首选治疗方法。心律失常消除后，心动过速性心肌病是可逆的。即使在小婴儿中，心动过速性心肌病的存在也是射频消融的指征。
