Study on the prognostic factors in the pediatric patients with arrhythmias using coronary sinus canulation, electrophysiologic study and endomyocardial biopsy

为了评价室上性心动过速（SVT）患者的心肌组织病理学，我们对11例室上性心动过速患者进行了研究。这些患者根据SVT类型分为两组；ⅰ组为不间断室上心动过速，ⅱ组为阵发性室上心动过速。虽然II组临床及血流动力学参数未见明显异常，但I组有3例患者临床表现为扩张型心肌病，心电图、胸部X-P异常，左心室运动减弱。I组2例患者和II组6例患者中有4例患者实现了SVT的诱导和终止。两组组织病理异常的发生率均较高，如肥大、变性、间质纤维化和紊乱。I组显著性病理发生率高于II组。我们目前的建议是，对于持续性或复发性室性心动过速患者，不仅要进行心内电生理检查，还要进行心内膜活检以评估心肌损伤，因为室性心动过速可能是心肌病的初始征象。就室性心律失常而言，室性心律失常的起源在右心室高于左心室。室性心律失常的临床特征和病因无显著性差异。约15%的室性心律失常患者有心肌累及，如心肌病或心肌炎。对室性心律失常进行适当的治疗，可以防止长时间的快速心律失常引起的心肌损伤进一步发展。

In order to evaluate myocardial histopathology in the patients with supraventricular tachycardia (SVT), eleven patients with SVT have been studied. These patients were divided into two groups with respect to the type of SVT ; group I was incessant SVT,group II was paroxysmal supraventricular tachycardia. Although there were no significant abnormalities in clinical and hemodynamic parameters in group II,three patients had clinical feature of dilated cardiomyopathy with abnormal ECG,chest X-P and hypokinesis on left ventriculogram in group I.Induction and termination of SVT were able to achieve in two patients of group I and in four out of six patients of group II.High incidence of histopathological abnormalities, such as hypertrophy, degeneration, interstitial fibrosis and disarray were noticed in both groups. The incidence of significant pathology was higher in group I than in group II.Our present recommendations are to perform not only intracardiac electrophysiologic study of patients with SVT who have incessant or recurrent type of SVT but also endomyocardial biopsy to evaluate myocardial demage, because SVT might be the initial sign of cardiomyopathy.As far as ventricular arrhythmias were concerned, the origin of the ventricular arrhythmia was higher in right ventricle than in the left ventricle. There was no significant difference between the clinical features and origin of the ventricular arrhythmias. About 15% of patients with ventriular arrhythmias had myocardial involvement such as cardiomyopathy or myocarditis. It is considered that proper treatment for the ventricular arrhythmias could prevent further development of myocardial demages due to prolonged tachyarrhythmias.