儿童心动过速性心肌病22例临床特征及疗效分析

Clinical characteristics and therapeutic effect of tachycardia-induced cardiomyopathy in 22 children

目的探讨儿童心动过速性心肌病(TIC)的临床特点、治疗方法及预后。方法回顾性分析2007年7月至2012年7月诊断为TIC的22例患儿的临床资料。结果 81.82%的TIC由房性心律失常所致,多见于男性小婴儿。TIC患儿经控制心律失常及强心、利尿、扩血管等治疗后症状缓解,心功能恢复正常,有效药物治疗时间平均(14.00±8.20)d。10例复发心动过速中7例见于房性心律失常患儿,经治疗后缓解。复发患儿中3例再发TIC,经治疗后心功能仍可恢复正常,但治疗时间较初次发作治疗时间延长,平均(19.50±8.40)d,差异有统计学意义(P<0.05)。5例TIC患儿于学龄前期行射频消融术后治愈。TIC患儿经治疗后超声心动图提示心功能明显改善,包括经体表面积标化后的左室舒张末内径、左室收缩末内径、左室射血分数、缩短分数均较治疗前好转,差异有统计学意义(P<0.05)。结论儿童TIC是一种可逆性、预后良好的心肌病。任何类型的快速心律失常均可诱发儿童TIC,并以房性心律失常多见,抗心律失常药物治疗是首选治疗方案;室性心律失常所致TIC需行射频消融术获得根治。

Objectives To explore the clinical symptoms, therapy and prognosis of tachycardia-induced cardiomyopathy （TIC） in children. Methods Clinical data of 22 children with TIC from July 2007 to July 2012 were retrospectively analyzed. Results TIC was mostly seen in male infants and 81.82%of TIC was caused by atrial arrhythmias. The clinical symptom relieved after arrhythmia and ventricular rates were under control with average effective treatment time of （14.00 ± 8.20） days. Ten patients had tachycardia recurrence, 7 of them had atrial arrhythmia and their clinical symptoms were improved after treatment;while 3 of them showed longer time of therapy with average treatment time of （19.50±8.40） days （P〈0.05）. Five children underwent radiofrequency ablation before school age and got good therapeutic effect. The post-treatment echocardiographic parameters showed cardiac function of TIC children was significantly improved after treatment, including left ventricular end-diastolic diameter index, left ventricular end-systolic diameter index, left ventricular ejection fraction and shortening score （all P〈0.05）. Conclusions Childhood TIC is a reversible myocardial dysfunction and its prognosis is good. TIC can be induced by various types of tachyarrhythmias and normally by atrial arrhythmia. The preferred treatment of TIC is administration of antiarrhythmic drugs but radiofrequency ablation is needed to ventricular arrhythmias induced TIC.