Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome
Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome
复制标题
儿童永久性交界性往复性心动过速：临床特征和结果的多中心研究
作者：
G. Vaksmann;C. D'hoinne;V. Lucet;S. Guillaumont;J. Lupoglazoff;A. Chantepie;I. Denjoy;E. Villain;F. Marçon
目的：探讨儿童持续性或永久性交界性往复性心动过速(PJRT)的临床特点、自然病史和最佳治疗方法。方法和结果：符合PJRT心电图标准的85例患者参加了一项多中心的回顾性研究。确诊时的年龄从出生到20岁不等(中位数3个月)。随访时间为0.1~26.0年(中位数8.2年)。在转诊时，85名患者中有24名(28%)患有充血性心力衰竭，所有患者都通过药物治疗得到了缓解。83名患者最初接受了药物治疗。胺碘酮和维拉帕米最有效，单用或联合地高辛的成功率为84-94%。18例行旁道射频消融术。消融时的年龄和手术结果之间有一种趋势，失败在更年轻的患者中更常见(6例手术中有3例成功，18例年龄较大的儿童中15例成功；p = 0.14)。2例超声心动图显示持续性左心功能不全但无充血性心力衰竭症状的患者，分别在确诊后1个月和3年突然死亡。19例(22%)PJRT自行消退。诊断PJRT时的年龄并不是自然消退的预测指标。结论：PJRT是心动过速所致心肌病患儿潜在的致死性心律失常。心动过速的自发消退并不少见。抗心律失常治疗通常是有效的。射频消融术应在年龄较大的儿童或心率不受控制的情况下进行，尤其是对持续性左心功能不全的患者。
Objectives: To investigate the clinical profile, natural history, and optimal management of persistent or permanent junctional reciprocating tachycardia (PJRT) in children. Methods and results: 85 patients meeting the ECG criteria for PJRT were enrolled in a retrospective multicentre study. Age at diagnosis varied from birth to 20 years (median 3 months). Follow up ranged from 0.1 to 26.0 (median 8.2) years. At the time of referral, 24 of 85 patients (28%) had congestive heart failure that was resolved with medical treatment in all patients. Eighty three patients received drug treatment initially. Amiodarone and verapamil were the most effective with a success rate of 84–94% alone or in association with digoxin. Radiofrequency ablation of the accessory pathway was performed in 18 patients. There was a trend for a relation between age at ablation and the result of the procedure, failures being more common in younger patients (three of six procedures in younger and 15 of 18 in older children were successful; p = 0.14). Two patients with persistent left ventricular dysfunction on echocardiography but with no symptoms of congestive heart failure died suddenly one month and three years after diagnosis. PJRT resolved spontaneously in 19 patients (22%). Age at diagnosis of PJRT was not a predictor of spontaneous resolution. Conclusions: PJRT is a potentially lethal arrhythmia in children with tachycardia induced cardiomyopathy. Spontaneous resolution of tachycardia is not uncommon. Antiarrhythmic treatment is often effective. Radiofrequency ablation should be performed in older children or when rate is not controlled, especially in patients with persistent left ventricular dysfunction.
影响因子：
2.8
作者：
PACKER, DL;BARDY, GH;GERMAN, LD
通讯作者：
GERMAN, LD