儿童特发性室性期前收缩临床特点及其对左心功能影响分析

doi:10.12372/jcp.2023.23e0116

Abstract

Abstract:

Objective To investigate the clinical features of idiopathic premature ventricular contractions (PVCs) in children, and to analyze the risk factors leading to left ventricular (LV) dysfunction. Methods The clinical data of idiopathic PVCs children hospitalized from July 2015 to December 2020 were retrospectively analyzed. Patients followed up for more than 3 years were divided into LVEF reduction group and LVEF unchanged group according to the left ventricular ejection fraction (LVEF) assessed by echocardiography at the third year. The risk factors of LVEF reduction in idiopathic PVCs children were analyzed. Results A total of 393 children with idiopathic PVCs (227 boys and 166 girls) were included, and the median age was 5.0 (2.0-8.0) years. Sixty-six children with symptoms mainly presented as chest tightness and chest pain and 273 cases of PVCs originated from right ventricle. The burden of PVCs in 284 children was less than 10%, and the highest burden was 46%. Two hundred and twelve children were followed up regularly within 2 years, and the total improvement rate at 24 months was 73.6%. There was no statistically difference in the recovery rate between patients with and without antiarrhythmic drugs (P>0.05). One hundred and forty-seven children were followed up for more than 3 years including 23 children in LVEF reduction group and 124 children in LVEF unchanged group. There were significant differences in the proportion of unsustained ventricular tachycardia and PVCs burden between the two groups (P<0.05).Multivariate logistic regression analysis showed that increased PVCs burden was an independent risk factor for LVEF reduction in idiopathic PVCs children (P<0.05), and the area under the ROC curve for predicting LVEF reduction in idiopathic PVCs children was 0.88 (95%CI: 0.79-0.96). Conclusions Idiopathic PVCs in children usually has no obvious symptoms, most of the children have a good prognosis, and antiarrhythmic drugs cannot improve the prognosis of PVCs in children. Children with idiopathic PVCs may occur LV dysfunction during a long follow-up period. The PVCs burden can be used as a predictor of LV dysfunction in children with idiopathic PVCs.

Key words: premature ventricular contraction, clinical feature, premature ventricular contractions burden, left ventricular ejection fraction

CHEN Ye, ZHOU Wanping, LI Xuan, HOU Miao, CAO Lei, SUN Ling, LYU Haitao. Clinical features of idiopathic premature ventricular contractions in children and its influence on left ventricular function[J].Journal of Clinical Pediatrics, 2023, 41(12): 925-930.

Figures/Tables 4

References 24

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项目	药物组(n=81)	非药物组(n=131)	统计量	P
男性[n(%)]	44(54.3)	76(58.0)	χ²=0.28	0.598
年龄[M(P₂₅~P₇₅)]/岁	4.0(2.0~7.0)	5.0(2.0~9.0)	Z=0.66	0.511
有临床症状[n(%)]	27(33.3)	17(13.0)	χ²=0.62	0.432
初诊PVC占总心搏比例[M(P₂₅~P₇₅)]/%	16.0(11.8~21.0)	7.0(4.8~8.8)	Z=11.11	<0.001
初诊LVEF（$\bar{x} \pm s$）/%	70.1±.4.6	70.2±4.2	t=0.10	0.924
随访1月好转[n(%)]	53(65.4)	79(60.3)	χ²=0.56	0.454
随访6月好转[n(%)]	56(69.1)	87(66.4)	χ²=0.17	0.681
随访12月好转[n(%)]	60(74.1)	87(66.4)	χ²=1.38	0.240
随访24月好转[n(%)]	64(79.0)	89(67.9)	χ²=3.06	0.080

项目	LVEF无改变组(n=124)	LVEF降低组(n=23)	统计量	P
男性[n(%)]	69(55.6)	15(65.2)	χ²=0.73	0.394
年龄[M(P₂₅~P₇₅)]/岁	4.0(2.0~9.0)	4.0(2.0~6.0)	Z=0.22	0.824
身高[M(P₂₅~P₇₅)]/cm	105.0(90.0~139.0)	103.0(90.0~124.0)	Z=0.42	0.675
体重[M(P₂₅~P₇₅)]/kg	17.0(13.0~30.8)	18.0(14.5~20.8)	Z=0.09	0.928
有临床症状[n(%)]	18(14.5)	1(4.3)	χ²=0.99	0.319
起源部位(左)[n(%)]	68(54.8)	12(52.2)	χ²=0.06	0.814
PVC联律[n(%)]	77(62.1)	14(60.9)	χ²=0.01	0.911
成对PVC[n(%)]	13(10.5)	2(8.7)	χ²=0.00	1.000
非持续性室速[n(%)]	13(10.5)	15(65.2)	χ²=9.36	0.006
插入性PVC[n(%)]	4(3.2)	0(0)	-	1.000¹⁾
PVC-QRS时限($\bar{x} \pm s$)/ms	108.6±23.6	112.4±25.0	t=0.80	0.483
PVC负荷[M(P₂₅~P₇₅)]/%	8.0(5.4~12.0)	20.3(16.0~28.4)	Z=5.69	<0.001
rmSSD($\bar{x} \pm s$)/ms	71.6±5.7	67.1±7.2	t=0.10	0.921
pNN50[M(P₂₅~P₇₅)]/%	26.0(18.0~38.0)	32.0(19.0~52.0)	Z=1.46	0.145
SDNN[M(P₂₅~P₇₅)]/ms	110.0(86.5~132.8)	106.0(85.0~139.0)	Z=0.24	0.810
PVC联律间期($\bar{x} \pm s$)/ms	409.7±83.2	401.7±76.6	t=0.90	0.669
PVC提前率($\bar{x} \pm s$)/%	0.7±0.1	0.7±0.1	t=0.53	0.614

危险因素	偏回归系数	标准误	χ²值	P	OR(95%CI)
PVC负荷	0.14	0.03	22.01	<0.001	1.16(1.09~1.23)
存在非持续性室速	0.68	0.73	0.86	0.355	1.97(0.47~8.26)
常量	-3.87	0.59	43.35	<0.001	-

Clinical features of idiopathic premature ventricular contractions in children and its influence on left ventricular function

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