经食管心房调搏在儿童不明原因心动过速中的应用

Application of transesophageal atrial pacing in children with unexplained tachycardia

目的探讨经食管心房调搏(TEAP)诊断儿童不明原因心动过速的临床价值。方法回顾分析2017年9月至2019年8月诊治的28例不明原因心动过速患儿行TEAP的结果,并与心内电生理检查对比。结果共28例经TEAP患儿,男19例、女9例,平均年龄(10.8±3.7)岁;房室折返性心动过速(AVRT)15例,房室结折返性心动过速(AVNRT)8例,心房内折返性心动过速(IART)2例,未诱发异位心动过速3例,诊断率为89.29%(25/28)。21例行心内电生理检查(IEPS),1例经TEAP未诱发异位心动过速,后经IEPS诊断为特发性右室流出道室性心动过速(RVOT-VT),1例左侧旁道房室折返性心动过速(LP-AVRT)诊断为房性心动过速(AT),其余的诊断两者均一致,符合率为90.48%(19/21)。结论TEAP诊断心动过速与IEPS符合率高,建议临床不明原因心动过速的患儿可以先行TEAP,以明确心动过速的诊断与分型,为下一步的诊治提供依据。

Objective To explore the clinical effect of transesophageal atrial pacing(TEAP)in the diagnosis of unexplained tachycardia in children.Methods The results of TEAP in 28 children with unexplained tachycardia diagnosed and treated from September 2017 to August 2019 were retrospectively analyzed and were compared with the intracardiac electrophysiological study.Results A total of 28 children(19 boys;9 girls)with an average age of 10.8±3.7 years were treated with TEAP.There were 15 cases of atrioventricular reentrant tachycardia(AVRT),8 cases of atrioventricular node reentrant tachycardia(AVNRT),and 2 cases of intra-atrial reentrant tachycardia(IART),and a diagnostic rate was 89.29%(25/28).The ectopic tachycardia was not induced in 3 cases.Intracardiac electrophysiological study(IEPS)was performed in 21 patients.One patient had no ectopic tachycardia induced by TEAP and was diagnosed with idiopathic right ventricular outflow tract ventricular tachycardia(RVOT-VT)by IEPS.One case of left bypass atrioventricular reentrant tachycardia(LP-AVRT)was misdiagnosed of atrial tachycardia(AT).The diagnosis results of other patients using IEPS were consistent with TEAP,and a coincidence rate was 90.48%(19/21).Conclusions The diagnosis of tachycardia by TEAP is highly consistent with the results of IEPS.TEAP is recommended for children with clinically unexplained tachycardia,so as to clarify the diagnosis and classification of tachycardia and provide evidence for further diagnosis and treatment.