儿童特发性室性心动过速的临床诊治特点探讨  

The characteristics of idiopathic ventricular tachycardia in children

作　　者：李筠[1] 周爱卿[1] 朱敏[1] 杨健萍[1] 黄美蓉[1] 高伟[1] 李奋[1] 余志庆[1] 张海燕[1] 

机构地区：[1]上海第二医科大学附属新华医院,200017

出　　处：《临床心电学杂志》2005年第1期31-33,共3页Journal of Clinical Electrocardiology

摘　　要：目的探讨儿童特发性室性心动过速(IVT)的临床诊治特点。方法对18例诊断为IVT的患儿,就其临床表现、心电图特征、部分患儿的运动试验(Brace方案)检查结果及临床治疗转归进行分析。结果1.儿童IVT主要起源于右心室流出道及左心室间隔;2.37%右室流出道IVT患儿有明显的心悸主诉,且与运动、情绪、感染等有关;90%左室IVT有心悸、面色苍白;3.右室流出道IVT常伴有频发室性早搏,VT多数为非持续性VT,运动试验VT的诱发率高;左室IVT均呈持续性VT发作,能为心房或心室的程序刺激所诱发;4.腺苷、β受体阻滞剂、钙通道阻滞剂能较好地防治IVT的发生;5.大多数儿童IVT具有很好的预后,射频消融能根治IVT。结论儿童IVT是发生于无器质性心脏病证据或致心律失常因素的一种VT,预后良好。有部分病人在疾病的某个过程需要药物的防治,其中大部分可以发展为不用药,甚至痊愈。对于症状严重、发作频繁的患儿,射频消融可使IVT得以根治。Objective To explore the characteristics of idiopathic ventricular tachycardia(IVT) in children. Method To analyze the clinical features,laboratory examination,management and outcomes in 18 pediatric patients with IVT. Results 1.The most common IVT in children oridinate from the right ventricular out flow tract(RVOT VT) and left ventricular aspect of the ventricular septum(ILVT). 2.In RVOT VT,only 37% of patients had symptoms;while 90% In ILVT. 3.The pattern of RVOT VT is repetitive monomorpic VT,they are often triggered by exercises. Adenosine and β-blockade are effective in RVOT VT. 4.The pattern of ILVT is sustained VT, which can be triggered with either atrial or venfricular pacing. ILVTs are exquisitely sensitive to verapamil. Conclusion IVT occurred in the patients with a structurally normal heart. The prognosis of IVT in children is generally good. There is a substantial number of patients requiring therapy at some point of the course of the disease,but it can be expected ,that a majority of the children affected will be free of the later on set. In case of relevant symptoms,catheter ablation seems a promising therapeutic option with the outlook for possible cure of the disease.

关 键 词：IVT 儿童 特发性室性心动过速 患儿 根治 左室 发作 右室流出道 临床诊治 射频消融 

分 类 号：R725.4[医药卫生—儿科]