婴幼儿左心室特发性室性心动过速临床研究

Clinical study of idiopathic left ventricular tachyeardia in infants and young children

目的探讨婴幼儿左心室特发性室性心动过速（idiopathic left ventricular tachycardia，ILVT）的临床特征、诊疗经过及预后，提高对该病的认识。方法对确诊ILVT的37例婴幼儿的临床资料进行回顾性总结，并进行统计学分析。结果37例ILVT患儿1岁以上者多见，男童好发，临床表现多样化，尿少伴水肿等心功能不全者5例，晕厥发作2例，烦躁哭闹、乏力多汗22例，无任何临床症状者8例。37例患儿中，20例（54．1％）为无休止陛发作，17例（45．9％）为短阵发作。9例（24．3％）患儿并发心动过速性心肌病（tachycardia—induced cardiomyopathy，TIC），其中8例继发于无休止性室性心动过速，无TIC患儿与TIC患儿心室率[（206．2±38．7）次／minvs．（171．8±38．7）次／min]和病程[（22．64-15．3）dvs．（9．8±6．0）d]比较，差异均有统计学意义（P均〈0．05）。34例患儿给予抗心律失常药物治疗，维拉帕米转复率较高（87．0％，20／23）。8例患儿药物治疗无效行射频消融根治。经随访，所有患儿恢复良好，TIC患儿在心动过速控制后，心脏结构及功能逐渐恢复正常[左心室舒张末期前后径：（35．4±7．2）mm vs．（28．9±5．6）mm，左室射血分数：（46．7±4．0）％VS．（70．1±1．5）％]，治疗前后差异有统计学意义（P〈0．01）。结论婴幼儿儿VT临床少见，病情轻重相差悬殊。持续无休止性发作、心室率越快及病程长易并发TIC。射频消融为有效根治方法。早期诊断并终止心动过速尤为重要，预后好。

Objective To analyze the clinical manifestations, diagnosis and treatment of idiopathic left ventricular tachycardia （ILVT） in infants and young children. Methods The clinical data, including manifestations,lab results and treatments of 37 cases of ILVT in infants and young children were analyzed retrospectively. Results ILVT were seen more in young children older than 1 year old and male infants. A total of 37 cases with ILVT showed diverse clinical manifestations,5 children had cardiac insufficiency with oliguria and edema, 2 children had syncope. There were 8 children without any symptoms, and 22 children had some symptoms, which mainly included agitation and crying, weakness and sweaty, vomitting and pale com- plexion. Holter showed incessant ILVT in 20 cases（54. 1% ） ,and paroxysmal in 17 cases（45.9% ）. Of the 37 cases ,9 cases presented tachycardia-induced cardiomyopathy （TIC）, 8 of them were secondary to the incessant ILVT. Children with TIC compared with those without TIC, the ventricular rate were faster [（206. 2 ± 38.7） beats/min vs. （ 171.8 ±38. 7）beats/min,P 〈0. 05] ,the duration were longerl （22. 6 ± 15. 3） days vs. （9. 8 ±6.0）days,P 〈0. 05]. A total of 34 cases were given by antiarrhythmic drugs,verapamil was higher effective in reversion to sinus rhythm. Radiofrequency ablations were conducted in 8 cases, resulting in ven- tricular tachycardia elimination. All of children were fine during following up periods. After successful control of tachycardia, left ventricular end-diastolic diameter and left ventricular ejection fraction in patients with TIC graduallyrecoveredI（35.4 ±7.2）mm vs. （28.9±5.6）mm, P〈0.05;（46.7±~4.0）% vs. （70.1 ± 1.5 ） %, P 〈 0. 01 ]. Conclusion ILVT in infants and young children are rare, and present different manifestions. An incessant ILVT with faster ventricular rate and longer duration are more frequently complicated by TIC. Radiofrequency ablation is the effective way of radical cure of the disease. The diagnosis and treatment for the tachycardia are particularly important in early time, and the prognosis are good.