Paroxysmal atrioventricular block in young patients.
Paroxysmal atrioventricular block in young patients.
复制标题
年轻患者阵发性房室传导阻滞。
作者：
Massimo Stefano Silvetti;G. Grutter;V. D. Di Ciommo;F. Drago
我们描述了17例患者（8名女孩和9名男孩），年龄9.6 ± 5.7岁，阵发性房室传导阻滞（PAVB），一种罕见的儿童疾病。霍尔特动态心电图显示PAVB 15例，倾斜试验4例（1例阳性）。7例心电图正常。获得性心脏病2例，先天性心脏病11例。7例患者出现晕厥或晕厥前期。有症状的患者ECG正常的频率明显更高。女孩和5岁以下儿童的停顿时间明显更长。6例患者仅在夜间记录PAVB，其他患者在全天记录PAVB。PAVB期间，6例患者的窦性心率降低，4例患者的窦性心率升高（通常为有症状的年轻女孩）。13例患者植入永久起搏器，其中7例无症状冠心病伴严重心动过缓患者。在随访期间（3.7 +/- 2.5年），1例患者发生完全AVB。尽管91%的起搏患者仍然存在PAVB，但由于起搏防止了暂停，因此症状没有复发。总之，PAVB是一种罕见的心律失常。自主神经系统功能障碍似乎在病因学中起作用，永久起搏是一种有效的治疗方法。
We describe 17 patients (8 girls, and 9 boys), aged 9.6 +/- 5.7 years, with paroxysmal atrioventricular block (PAVB), a condition rarely described in children. Holter monitoring documented the PAVB in 15 patients, and tilt test was performed in 4 patients (positive in 1). The electrocardiograph (ECG) was normal in 7 patients. Two patients had acquired and 11 patients had congenital heart disease (CHD). Syncope or presyncope were present in 7 patients. A normal ECG was significantly more frequent in symptomatic patients. Pauses were significantly longer in girls and in children <5 years. PAVB was recorded only during nocturnal hours in 6 patients and throughout the day in the others. The sinus rate decreased during PAVB in 6 patients and increased in 4 (generally younger girls with symptoms). Permanent pacemakers were implanted in 13 patients, including 7 asymptomatic patients with CHD and severe bradycardia. During follow-up (3.7 +/- 2.5 years), 1 patient developed complete AVB. Although PAVB was still present in 91% of paced patients, symptoms did not recur because pacing prevented the pauses. In conclusion, PAVB is a rare arrhythmia. Autonomic nervous system dysfunction seems to play an etiological role and permanent pacing was an effective treatment.