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

为了研究室上性心动过速(SVT)患者的心肌组织病理学改变，对11例SVT患者进行了研究。根据室上性心动过速的类型分为两组：I组为持续性室上性心动过速，II组为阵发性室上性心动过速。尽管II组的临床和血流动力学参数未见明显异常，但I组有3例患者有扩张型心肌病的临床特征，并伴有心电图、胸部X-P异常和左心室图上的运动减退。I组2例和II组6例中4例均能诱发和终止SVT。建议对反复或复发性室性心动过速患者进行心内电生理检查和心内膜活检以评估心肌损害，因为室性心动过速可能是心肌病的首发征象。室性心律失常的临床特征和起源无明显差异。约15%的室性心律失常患者有心肌损害，如心肌病或心肌炎。认为对室性心律失常进行适当的治疗可以防止因长时间的快速性心律失常而进一步发展心肌损害。

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.