临床儿科杂志 ›› 2023, Vol. 41 ›› Issue (8): 599-603.doi: 10.12372/jcp.2023.22e0465

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儿童特发性左室室性心动过速临床分析

邬晓玲, 吕铁伟()   

  1. 重庆医科大学附属儿童医院心血管内科 儿童发育疾病研究教育部重点实验室 国家儿童健康与疾病临床医学研究中心 儿科学重庆市重点实验室(重庆 400014)
  • 收稿日期:2022-04-18 出版日期:2023-08-15 发布日期:2023-08-10
  • 通讯作者: 吕铁伟 E-mail:ltw200145@163.com

Clinical analysis of idiopathic left ventricular tachycardia in children

WU Xiaoling, LYU Tiewei()   

  1. Department of Cardiology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing Key Laboratory of Pediatrics; Chongqing 400014, China
  • Received:2022-04-18 Online:2023-08-15 Published:2023-08-10
  • Contact: LYU Tiewei E-mail:ltw200145@163.com

摘要:

目的 分析并总结儿童特发性左室室性心动过速(ILVT)的临床特点及治疗效果。方法 回顾性分析2010年1月—2021年4月于心血管内科住院治疗的ILVT患儿的临床资料。结果 纳入31例ILVT患儿,中位首发年龄7.8(3.3~10.8)岁。男21例、女10例,首发年龄为6~18岁共18例(58.1%)。接受射频消融的患儿(手术组,14例)的首发年龄为9.4(6.7~11.7)岁,大于未接受射频消融的患儿[非手术组,17例,5.4(0.4~9.6)岁],差异有统计学意义(P<0.05)。27例室性心动过速发作无明确诱因。10例患儿以心慌、胸闷、心前区不适为主要表现。非手术组和手术组临床症状严重程度分布差异有统计学意义(P<0.05),非手术组临床表现较轻微。抗心律失常药物以维拉帕米及普罗帕酮疗效较好,复律有效率分别为100%和64.7%。射频消融手术治疗的即刻成功率100%,远期随访2例复发再次手术后恢复正常。结论 ILVT多发生在学龄期,无明确诱因,临床症状不重,大多药物治疗反应好且预后良好,对于反复发作且药物疗效欠佳者可行射频消融治疗。

关键词: 特发性左室室性心动过速, 临床特点, 射频消融, 儿童

Abstract:

Objective To analyse and summarize the clinical characteristics and treatment of idiopathic left ventricular tachycardia (ILVT) in children. Method The clinical data of 31 children with ILVT hospitalized in our hospital from January 2010 to April 2021 were retrospectively analysed. Results The median first onset age of 31 children with idiopathic left ventricular tachycardia was 7.8(3.3-10.8) years. There were 21 males and 10 females, with 18 cases (58.1%) whose first onset age was 6 to 18 years. The first onset age of 14 children who received radiofrequency catheter ablation (operation group) was 9.4(6.7-11.7) years, which was greater than that of the children who did not undergo radiofrequency ablation [non-surgical group, 17 cases, 5.4 (0.4-9.6) years old], with a statistically significant difference (P<0.05). Twenty-seven episodes of ventricular tachycardia had no clear triggering cause. 10 cases had panic, chest tightness, and precordial discomfort as the main clinical manifestations. The difference in the distribution of clinical symptom severity between the non-surgical group and the surgical group was statistically significant (P<0.05), with the non-surgical group having milder clinical manifestations.Verapamil and propafenone are more effective among vein-injected antiarrhythmic drugs and the effective rates were 100% and 64.7% respectively. The immediate success rate of radiofrequency catheter ablation was 100%, and two cases got recovered after reoperation during long-term follow-up. Conclusion ILVT occurs mostly in school age, with no clear inducement, and its manifestations are not serious. Most patients have good response to drugs and favourable prognosis. Radiofrequency catheter ablation is feasible for patients with recurrent attacks and poor drug efficacy.

Key words: idiopathic left ventricular tachycardia, clinical characteristics, radiofrequency catheter ablation, pediatrics