平板运动试验对儿童儿茶酚胺敏感性多形性室性心动过速的诊治价值分析

Value of treadmill exercise test in children with catecholaminergic pleomorphic ventricular tachycardia

目的分析儿茶酚胺敏感性多形性室性心动过速(CPVT)患儿的平板运动试验特点,探讨其在CPVT患儿诊治中的意义。方法回顾性分析2015年1月至2019年9月就诊于清华大学第一附属医院心脏中心小儿科的18例CPVT患儿,依据指南推荐进行规律治疗,服用普萘洛尔或美托洛尔,部分联合普罗帕酮。治疗前后进行平板运动试验,对比相关数据。结果(1)治疗前,平板运动试验显示,18例患儿均诱发室性期前收缩(室性早搏),16例(88.9%)诱发室性心动过速(室速)。发生室速的阈值心率(147±15)次/min与基础心率67(61,81)次/min相比差异有统计学意义(Z=3.517,P<0.01),与发生室性早搏的阈值心率115(108,123)次/min相比差异有统计学意义(Z=3.521,P<0.01)。(2)治疗后,15例患儿的平板运动试验显示,15例均诱发室性早搏,9例(60.0%)诱发室速。发生室速的阈值心率(138±13)次/min与基础心率(65±12)次/min相比差异有统计学意义(t=16.913,P<0.01),与发生室性早搏的阈值心率(105±14)次/min相比差异有统计学意义(t=8.098,P<0.01)。(3)治疗前后平板运动试验比较,患儿室性早搏的阈值心率、室性早搏的发生阶段、室性早搏到室速的间隔时间、最大运动负荷差异均有统计学意义(均为P<0.05);而基础心率、室性早搏的形态、室速的阈值心率、室速的发生阶段、室速的形态、运动终止恢复窦性心律的时间、恢复窦性心律时的心率的差异均无统计学意义(均为P>0.05)。结论CPVT患儿平板运动试验诱发室性心律失常阳性率高,对CPVT的诊断和治疗有重要价值。

Objective To analyze the characteristics of treadmill exercise test in pediatric patients with catecholaminergic polymorphic ventricular tachycardia(CPVT),and explore its value for diagnosis and treatment.Methods Eighteen pediatric patients with CPVT in the First Hospital of Tsinghua University were retrospectively enrolled from January 2015 to September 2019.All patients received the guideline recommended medication.Propranolol or metoprolol were initially used and some of them added propafenone.Treadmill exercise test was carried out before and after treatment.Clinical data and electrocardiographic data were collected.Results(1)Before treatment(n=18),all patients showed ventricular premature beat(VPB)in treadmill exercise test,16 of them(88.9%)showed ventricular tachycardia(VT).The heart rate(HR)threshold of VT was significantly higher than rest HR[(147±15)bpm vs.67(61,81)bpm,Z=3.517,P<0.001]and the HR threshold of VPB[(147±15)bpm vs.115(108,123)bpm,Z=3.521,P<0.001].(2)After treatment(n=15),all of them showed VPB in treadmill exercise test and 9 patients(60.0%)showed VT.HR threshold of VT was significantly higher than rest HR[(138±130)bpm vs.(65±12)bpm,t=16.913,P<0.001]and HR threshold of VPB[(138±13)bpm vs.(105±14)bpm,t=8.098,P<0.001].(3)Rest HR,threshold HR of VPB,occurrence of VPB,time interval from VPB to VT,and peak exercise load before and after treatment were significantly different(all P<0.05).No significant differences were found on morphology of VPB,threshold HR of VT,occurrence of VT,morphology of VT,time interval from exercise termination to recovery of sinus rhythm,HR on recovery of the sinus rhythm(all P>0.05).Conclusions High prevalence of ventricular arrhythmias is showed in treadmill exercise test in pediatric patients with CPVT.The test is an important tool for the diagnosis and treatment of CPVT in pediatric patients.