摘要
目的探讨食管心房调搏术(TEAP)对婴幼儿快速型心律失常的分型诊断和治疗效果。方法回顾分析2005年1月至2016年12月收住的86例年龄≤3岁,经药物治疗无效后行TEAP诊治的快速型心律失常患儿的临床资料。经体表和食管心电图确定阵发性室上性心动过速(PSVT)54例,房扑(AF)26例,房性心动过速(AT)3例,窦性心动过速伴Ⅰ°房室传导阻滞(AVB)、交界性异位性心动过速及特发性室速(IVT)各1例。根据病程中TEAP治疗次数对PSVT和AF患儿进行分组,分为单次治疗组和≥2次的多次治疗组,进行比较。结果 86例患儿中,男49例、女37例,中位数年龄56.00 d(16.75~250.00 d)。除1例PSVT但TEAP证实为窦速伴Ⅰ?-AVB者未超速转复,85例采用超速抑制法转复成功66例,总转复成功率77.6%;其中PSVT转复成功率90.7%,AF转复成功率57.7%,AT和IVT各1例复律成功。PSVT和AF患儿中,单次治疗组与多次治疗组患儿的年龄、性别、心室率以及伴发基础疾病构成比等差异无统计学意义(P>0.05)。PSVT伴心功能不全者占18.5%(10/54),AF伴心功能不全占30.8%(8/26)。PSVT和AF复律成功与患儿心功能不全无显著相关性(P>0.05)。结论婴幼儿快速型心律失常采用TEAP诊断准确、可靠;TEAP是紧急、快速终止药物难治性PSVT的有效方法,尤其对于伴有心功能不全者。
Objective To explore the efficacy of transesophageal atrial pacing(TEAP)in the diagnosis and treatment for infants with tachyarrhythmia.Method The clinical data of 86 children with tachyarrhythmia under 3 years old who were treated with TEAP after ineffective drug treatment from January 2005 to December 2016 were retrospectively analyzed.Diagnosed by surface and esophageal electrocardiogram,there were 54 cases of paroxysmal supraventricular tachycardia(PSVT),26 cases of atrial flutter(AF),3 cases of atrial tachycardia(AT),1 case of sinus tachycardia withⅠ°atrioventricular block(AVB),1 case of junctional ectopic tachycardia and 1 case of idiopathic ventricular tachycardia(IVT).PSVT and AF children were divided into single treatment group and multiple treatment group(≥2 times)according to the times of TEAP treatment,and the differences were compared.Results In the 86 cases(49 males and 37 females)median age was 56 d(16.75~250.00 d).Except one case of PSVT who was proved to be sinus tachycardia withⅠ°-AVB by TEAP,66 cases in 85 cases were successfully terminated by overspeed inhibition and the total success rate was 77.6%.The successful conversion rate was 90.7%in PSVT and 57.7%in AF.One AT and one IVT were converted to sinus rhythms successfully.In children with PSVT and AF,there was no significant difference in age,sex,ventricular rate and the proportion of underlying diseases between single treatment group and multiple treatment group(P>0.05).PSVT with cardiac insufficiency accounted for 18.5%(10/54),and AF with cardiac insufficiency accounted for 30.8%(8/26).There was no significant correlation between the successful rate of conversion and cardiac insufficiency in PSVT and AF children(P>0.05).Conclusion TEAP is an accurate and reliable diagnosis of infant fast arrhythmia,and is an effective method for emergent and rapid termination of drug-refractory PSVT,especially for patients with cardiac insufficiency.
作者
徐萌
王健怡
肖婷婷
谢利剑
李筠
黄敏
XU Meng;WANG Jianyi;XIAO Tingting;XIE Lijian;LI Yun;HUANG Min(Department of Cardiology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2018年第4期277-281,共5页
Journal of Clinical Pediatrics
