食管心房调搏术在婴幼儿室上性心动过速中的应用

Application of Transesophageal Atrial Pacing in Infants with Supraventricular Tachycardia

目的探讨食管心房调搏术(TEAP)在婴幼儿室上性心动过速(SVT)诊断和治疗中的应用价值。方法选取43例年龄<2岁的SVT婴幼儿。其中男23例,女20例;年龄(7.59±9.80)个月。采用TEAP检查,随后根据记录食管心电图进行分型诊断,明确为折返性心动过速、房性心动过速、房性扑动后立即进行超速抑制终止心动过速。并对其资料进行回顾性分析。结果 43例SVT婴幼儿经食管电生理检查,心室率为(233.31±46.79)次.min-1。其中29例次SVT中诊断为折返型SVT23例次,房性动过速3例次,窦性心动过速并Ⅰ度房室传导阻滞(Ⅰ-AVB)2例次,窦性心动过速1例次,房性扑动14例次。宽QRS心动过速2例,1例为Ⅰ-AVB并室内传导阻滞,另1例经随访确诊为交界性心动过速并室内传导阻滞。经TEAP成功转复率为83%(34/41例)。结论婴幼儿SVT往往伴较快心室率,如不及时救治极易产生不可逆的损害。TEAP的应用有助于婴幼儿SVT的诊断分型,而且其安全快速转复窦性心律的优点在婴幼儿心动过速的抢救中起重要作用。

Objective To explore the value of transesophageal atrial pacing（TEAP） in diagnosis and treatment of supraventricular tachycardia（SVT） in infants.Methods Forty-three children with SVT were diagnosed and treated by TEAP technique,23 boys,20 girls,the age of the patients was（7.59±9.80）months.The patients with reentrant tachycardia,atrial tachycardia and atrial flutler were treated by overspeed inhibition.Results Forty-three infants received TEAP,and their average ventricular rate was（233.31±46.79） times.min-1.Among 29 SVT cases,23 cases were reentrant tachycardia,3 cases were atrial tachycardia,2 cases were sinus tachycardia with Ⅰ-atrioventricular block（Ⅰ-AVB） and 1 case was sinus tachycardia among 29 SVT cases.Fourteen cases had atrial flutler.Two cases were tachycardia with wide QRS wave.One case was Ⅰ-AVB and another case was junctional tachycardia with block intra-ventricular.The returned rate was 83%（34/41 cases） by TEAP.Conclusions SVT in infants is often companied with the rapid heart rate,and needs immediate management.TEAP can help to diagnose the infants with SVT,and play an important role in the rescue of SVT children for its safety and fast returned ability.