新生儿无结构性心脏病阵发性室上性心动过速的临床特点和结局

Clinical features and outcomes of paroxysmal supraventricular tachycardia in neonates without structural heart disease

目的分析新生儿无结构性心脏病阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)的临床特点和结局。方法回顾性收集2019年1月至2022年6月在青岛大学附属妇女儿童医院接受治疗并随访的无结构性心脏病PSVT新生儿的数据资料。分析这些患儿的胎儿期病史、出生后PSVT首次发生时间、抗心律失常治疗和随访结局等。根据有无胎儿期PSVT病史,将患儿分为2组。分析PSVT首次发生时间、初诊时持续性心动过速比例及住院次数等临床资料。采用t检验、Mann-Whitney U检验或Pearsonχ^(2)检验进行统计学分析。结果共72例患儿纳入本研究。72例患儿出生胎龄(38.8±1.8)周,出生体重(3260±330)g;26例(36.1%)有胎儿期PSVT病史,46例(63.9%)无胎儿期PSVT病史。72例出生后PSVT首次发生时间为2.1 d(0.3~13.7)d。应用的抗心律失常药物包括普罗帕酮44例(61.1%)、胺碘酮28例(38.9%)和西地兰14例(19.4%)。44例(61.1%)接受单一药物治疗,26例(36.1%)接受双联治疗,2例(2.8%)接受三联治疗。38例(52.8%)患儿接受6个月、20例(27.8%)患儿接受12个月预防性药物治疗。14例(19.4%)在随访期内仍有心动过速发作,未能停药。随访期(12个月)内,所有患儿未发生重大疾病,无死亡。有胎儿期PSVT病史的患儿PSVT首次发生时间早于无该病史的患儿[0.2 d(0.0~0.7 d)与12.0 d(2.2~15.0)d,Z=-4.83,P<0.001],且初诊时持续性心动过速比例更高[76.9%(20/26)与39.1%(18/46),χ^(2)=4.76,P=0.029],住院次数更多[4.0次(3.0~7.0次)与1.0次(1.0~1.0次),Z=-3.52,P<0.001],预防性抗心律失常药物治疗时间更长[12.0个月(10.5~21.0个月)与6.0个月(3.0~6.0个月),Z=-4.17,P<0.001]。结论应重视无结构性心脏病新生儿PSVT的筛查,尤其是有胎儿期PSVT病史者。此类患儿生后首次出现PSVT的时间更早,初诊时以心动过速持续性发作为主且易复发,预防性药物治疗时间也更长。

Objective To analyze the clinical features and outcomes of paroxysmal supraventricular tachycardia(PSVT)in neonates without structural heart disease.Methods A retrospective study was conducted on PSVT neonates without structural heart disease who were treated and followed up at the Women and Children's Hospital,Qingdao University,from January 2019 to June 2022.Clinical data,including the prenatal history of PSVT,the time at first onset of PSVT after birth,anti-arrhythmic treatment,and follow-up outcomes,were collected and analyzed.These patients were divided into two groups based on the presence and absence of fetal PSVT history.Differences in the clinical data between the two groups were compared,including the time at first onset of PSVT,the proportion of patients with persistent tachycardia at initial diagnosis,and hospitalization frequency.Statistical analysis was performed using t-test,Mann-Whitney U test,or Pearson's Chi-square test.Results A total of 72 neonates with PSVT were included,with an average gestational age at delivery of(38.8±1.8)weeks and an average birth weight of(3260±330)g.There were 26(36.1%)cases with a prenatal history of PSVT,while 46(63.9%)cases without.The median time at the first onset of PSVT after birth was 2.1(0.3-13.7)d.Anti-arrhythmic drugs used for the patients included propafenone(44 cases,61.1%),amiodarone(28 cases,38.9%),and cedilanid(14 cases,19.4%).There were 44 cases(61.1%)received single drug therapy,26(36.1%)receiving dual therapy,and only two(2.8%)receiving triple therapy.Prophylactic drugs were administered to 38 patients(52.8%)for six months,and 20(27.8%)for 12 months.Fourteen cases(19.4%)still exhibited tachycardia during follow-up and continued their drug therapy.No major illnesses or deaths occurred in the 72 patients during a 12-month follow-up.Compared with the patients without a history of fetal PSVT,those with a history of fetal PSVT had an earlier onset of PSVT after birth[0.2 d(0.0-0.7 d)vs.12.0 d(2.2-15.0 d),Z=-4.83,P<0.001],a high rate of persistent tachycardia at first diagnosis[76.9%(20/26)vs.39.1%(18/46),χ^(2)=4.76,P=0.029],more hospitalizations[4.0 times(3.0-7.0 times)vs.1.0 times(1.0-1.0 times),Z=-3.52,P<0.001],and longer duration of preventive anti-arrhythmic treatment[12.0 months(10.5-21.0 months)vs.6.0 months(3.0-6.0 months),Z=-4.17,P<0.001].Conclusion Attention should be given to PSVT screening in neonates without structural heart disease,particularly for those with a history of fetal PSVT,who tend to have an early onset of PSVT after birth,persistent tachycardia at first diagnosis with high rates of recurrence and require longer preventive anti-arrhythmic treatment.