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目的 评价无创伤性电生理检查在儿童室上性心动过速(PSVT)诊断中的应用价值。方法 2002年1月至 2003年 12月对广东省心血管研究所 58例室上性心动过速 (PSVT)患儿进行体表 12导联心电图检查(ECG)、食管电生理检查(TEAP),并与心内电生理检查 (EPS)结果进行比较。结果 ECG对房室折返性PSVT(AVRP)诊断敏感性为 100% ( 20 /20 );但对 5例P波不明显的房室结折返性PSVT(AVNRP)均漏诊;TEAP对AVRP和AVNRP总诊断敏感性为 90 3% (28 /31),对AVNRP无漏诊;ECG和TEAP对PSVT诊断符合率分别为80% (20 /25)和 91% (30 /33)。结论 联合应用ECG和TEAP等无创性电生理检查能对儿童PSVT作出正确诊断及分型,是一种安全可靠、无痛性的检查方法。 相似文献
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目的:探讨食道心房调搏术在小儿室上性心动过速(室上速)的应用及临床意义。方法:对28例室上速病儿进行了食道心房调搏检测,并对结果进行分析。结果:诱发出室上速发作26例(92.8%),其中房室折返性心动过速14例(53.8%),房室结折返性心动过速8例(30.8%),房内折返心动过速3例,未定型1例。以短阵超速抑制法可终止心动过速24例,药物可终止心动过速22例。与进行了心内电生理检查的6例比较,结果基本相符。结论:经食道心房调搏术是一种适用于小儿的安全可靠、简便无创的心脏电生理学检查方法,对小儿室上性心动过速的诊断、鉴别诊断及选择治疗方案有重要作用。 相似文献
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小儿阵发性室上性心动过速的电生理学机制 总被引:2,自引:0,他引:2
为了解阵发性室上性心动过速的产生机制,用心内电生理学方法检查31例阵发性室上性心动过速(简称室上速)患儿。结果:房室结折返9例,均为慢快型;房室折返共22例,其中隐匿性附加束11例,预激综合征10例,Mahaim束1例。异丙肾上腺素和阿托品可使双通道显示,三通道变为双通道并利于室上速的产生。如双通道和附加束同时存在,室上速开始时折返环可以不固定。提示,室上速以房室折返为主,同一病例中可以有不同的折返回路及诱发因素。 相似文献
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我们自1988年以来,应用食道心房调搏术(TEAP)对34例阵发性室上性心动过速(PSVT)患儿作出分型诊断;同时应用程序电刺激评价和指导临床用药,取得了较满意的疗效.全组病例均为一次静脉给药(异搏定、胺碘酮、异丙吡胺)后复律.无1例应用电转复治疗者.1年后复发律为5.88%.同时,选择了31例PSVT 患儿,应用异搏定、胺碘酮、异丙吡胺等药物作常规转复,结果显示:用药疗程较长,疗效不稳定;仅电击复律数即迭9人.1年后复发率为38.71%.两组对照,经统计学处理,P<0.005,有极显著差异. 相似文献
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目的探讨新生儿阵发性室上性心动过速(PSVT)的临床特点、急诊处理方法并总结成功治疗经验。方法回顾本院21例新生儿PSVT的一般资料、临床特点、心电图表现、转复治疗方法、随访结果和预后进行分析。结果新生儿PSVT临床主要表现为面色苍白、神萎、拒奶、紫绀、心率大于210次/min,经心电图确诊为PSVT,5例合并预激综合征。4例通过兴奋迷走神经转复成功,11例药物转复成功,6例经上述方法无效后予食道心房调搏进行超速抑制转复成功。所有病例转复后都予地高辛加心得安维持治疗3-6个月。随访2年治愈20例,仅1例复发。结论新生儿PSVT往往无特异性临床表现与年长儿不同,诊断主要依赖体表心电图,部分合并预激综合征。转复治疗中兴奋迷走神经和药物转复均有一定疗效,但食道心房调搏更为迅速有效、安全、可重复且无副作用,值得临床推广应用。新生儿PSVT预后好。 相似文献
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新生儿阵发性室上性心动过速临床特点及急诊处理 总被引:5,自引:2,他引:5
目的探讨新生儿阵发性室上性心动过速(PSVT)的临床特点、急诊处理方法并总结成功治疗经验。方法回顾本院21例新生儿PSVT的一般资料、临床特点、心电图表现、转复治疗方法、随访结果和预后进行分析。结果新生儿PSVT,临床主要表现为面色苍白、神萎、拒奶、紫绀、心率大于210次/min,经心电图确诊为PSVT,5例合并预激综合征。4例通过兴奋迷走神经转复成功,11例药物转复成功,6例经上述方法无效后予食道心房调搏进行超速抑制转复成功。所有病例转复后都予地高辛加心得安维持治疗3~6个月。随访2年治愈20例,仅1例复发。结论新生儿PSVT往往无特异性临床表现与年长儿不同,诊断主要依赖体表心电图,部分合并预激综合征。转复治疗中兴奋迷走神经和药物转复均有一定疗效,但食道心房调搏更为迅速有效、安全、可重复且无副作用,值得临床推广应用。新生儿PSVT预后好。 相似文献
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小儿室上性心动过速87例临床分析和治疗药物选择 总被引:4,自引:0,他引:4
目的探讨小儿室上性心动过速(SVT)诊断和分型中体表心电图的价值以及如何合理应用治疗SVT的药物。方法分析87例经过电生理检查的SVT患儿临床资料。结果89.7%的病例能通过体表心电图正确诊断及定位。SVT构成比为:房室折返性心动过速(AVRT)66.7%,房室结折返性心动过速(AVNRT)27.6%,其他5.7%。AVRT患儿应用普罗帕酮转复率为94.9%,维拉帕米为71.4%,ATP为75.0%,地高辛为62.5%;AVNRT用普罗帕酮转复率为83.3%,维拉帕米为90.0%,ATP为100.0%,地高辛为66.7%。药物不良反应发生率为:普罗帕酮14.8%,维拉帕米31.6%,ATP18.8%,地高辛18.2%。结论正确运用体表心电图诊断和定位以及药物治疗能有效地解决小儿SVT的诊疗问题,几种治疗SVT的药物对不同类型SVT的治疗价值各不相同,应用时应遵循一定的原则。 相似文献
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Aims: To determine (a) the age distribution at first clinical supraventricular tachycardia (SVT) presentation; (b) the time interval between first clinical suspicion and electrocardiographic proof of SVT; c) the most indicative symptoms and signs of SVT; and (d) the SVT mechanism and its age distribution according to surface ECG. Methods: The records of 55 children (32 males and 23 females) with electrocardiographically proven SVT but without congenital heart disease were reviewed. Results: At diagnosis, 27 patients (49%) were younger than 1 y (infants), and 28 (51%) were older than 1 y (children). Only a quarter of infants presented with symptoms. The majority (20/27), however, were detected during routine investigation without having any complaints. Children presented with symptoms (mostly palpitations) in almost 90% of cases. Despite these symptoms, the median time interval between first clinical presentation suggestive of SVT and electrocardiographic proof of SVT was 138 d. Using surface ECG, we were unable to show any age-dependency of the SVT mechanism in our study group.
Conclusion: In infants SVT is a chance finding; SVT can only be proven electrocardiographically with a median delay of 138 d, despite the presence of symptoms; SVT using a (concealed) accessory pathway is the most common mechanism 相似文献
Conclusion: In infants SVT is a chance finding; SVT can only be proven electrocardiographically with a median delay of 138 d, despite the presence of symptoms; SVT using a (concealed) accessory pathway is the most common mechanism 相似文献
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Summary A 3 1/2-year-old child with incessant supraventricular tachycardia was investigated with intravenous vago-mimetic drugs, which had unexpected beneficial results. These observations suggested selection of digitalis as the antiarrhythmic drug, which would not otherwise have been chosen. The potential advantages of non-invasive, acute autonomic modulation for optimal drug selection in children with arrhythmias are illustrated by this case. 相似文献
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R. P. LEITNER R. E. HAWKER J. M. CELERMAJER 《Journal of paediatrics and child health》1983,19(1):40-44
ABSTRACT. Fifty-four spontaneous episodes of paroxysmal supraventricular tachycardia (PSVT) in 23 patients, varying in age from one day to fourteen years, were treated with intravenous verapamil according to a specific protocol.
Stable sinus rhythm was obtained promptly with no side effects in 76% of episodes. There was no response in 9%; an unstable rhythm in 7.5%; and severe side effects (hypotension, sinus bradycardia and cardio-respiratory arrest) in 7.5%. All severe side effects were associated with larger than recommended doses of verapamil.
Intravenous verapamil reverted 100% of all episodes of idiopathic PSVT in eight patients; 83% of episodes in five patients with congenital heart disease; and only 57% of episodes in nine patients with Wolff-Parkinson-White syndrome. It was ineffective in one neonate who had had intra-uterine SVT. 相似文献
Stable sinus rhythm was obtained promptly with no side effects in 76% of episodes. There was no response in 9%; an unstable rhythm in 7.5%; and severe side effects (hypotension, sinus bradycardia and cardio-respiratory arrest) in 7.5%. All severe side effects were associated with larger than recommended doses of verapamil.
Intravenous verapamil reverted 100% of all episodes of idiopathic PSVT in eight patients; 83% of episodes in five patients with congenital heart disease; and only 57% of episodes in nine patients with Wolff-Parkinson-White syndrome. It was ineffective in one neonate who had had intra-uterine SVT. 相似文献
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We report on two cases of mechanical termination of supraventricular tachycardia by chest thump which were followed by serious complications. In a 3-year-old boy with an otherwise normal heart, incessant supraventricular tachycardia was converted to sinus rhythm by a single precordial thump. This, however was followed by thrombo-embolic infarction of the left-sided middle cerebral artery. In another case of a 9-year-old girl, recurrent episodes of supraventricular tachycardia were associated with Ebstein anomaly of the tricuspid valve. Chest thump was successful in terminating supraventricular tachycardia but induced a short run of ventricular tachycardia which terminated itself and was then followed by sinus rhythm. It is concluded that even a slight precordial thump implies undetermined risks in the acute management of supraventricular tachycardia in children and should therefore be abandoned in favour of other methods. 相似文献
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Re-entrant supraventricular tachycardia is the most common cardiac arrhythmia in infancy. Pharmacological prevention of recurrencies
is a standard recommendation for infants less than 1 year of age. In view of the often benign spontaneous clinical course
of the disease, the risk-benefit analysis of any antiarrhythmic agent given is important. It was the aim of this retrospective
study, to assess the value of oral long-term digoxin given to paediatric patients with supraventricular tachycardia with onset
in the first 4 months of life. Twenty-six newborns and infants fulfilled the inclusion criteria. Median age at first presentation
of the patients was 7 days. Eight patients (31%) had structural heart disease, 9 patients had a pre-excitation syndrome, and
the other 17 children had a concealed accessory atrioventricular pathway. Long-term prophylaxis with oral digoxin was considered
successful in 17 children (65%). In 2 patients therapy with digoxin was considered partially effective and in 7 patients (27%)
failure of digoxin to improve symptoms led to the introduction of other anti-arrhythmic agents. Serum digoxin levels were
no different in the patients with successful therapy as compared to those with treatment failure. No side-effects due to digoxin
were noted in all the patients treated. After a mean followup of 54 months (12–130 months), 19 children (73%) were free of
recurrencies and on no medication, 5 children were free of recurrencies but had anti-arrhythmic therapy. Only 2 patients,
both on anti-arrhythmic therapy, were still suffering from tachycardia.
Conclusion Digoxin remains an effective treatment option in infants with supraventricular tachycardia and it helped to avoid the long-term
use of other anti-arrhythmic drugs with potentially more serious side-effects (pro-arrhythmia) in a considerable proportion
of infants treated.
Received: 29 April 1997 / Accepted in revised form: 31 July 1997 相似文献
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Propranolol, a first-generation nonselective β-adrenoceptor blocking agent, is commonly used to treat pediatric arrhythmias.
Atenolol, relatively longacting, cardioselective β-adrenoceptor blocking agent, has been successfully used in adults with
supraventricular tachycardia (SVT). There is only one report on the use of atenolol in children with SVT, and our report is
on the first long-term prospective study to evaluate the use of atenolol in children. A group of 22 children <18 years of
age with clinical SVT were enrolled in the study. The tachycardia was documented on electrocardiograms in each case and was
confirmed by electrophysiologic studies in some. Once-a-day oral atenolol was started as a monotherapy. Of the 22 children
with various types of SVT, 13 (59%) were well controlled on long-term oral atenolol therapy. The effective dose of atenolol
ranged between 0.3 and 1.3 mg/kg/day (median effective dose 0.7 mg/kg/day). Five children had some adverse effects. However,
none in the successful group of 13 patients required drug discontinuation because of such effects. Once-a-day oral atenolol
as a monotherapy is effective and relatively safe for long-term management of SVT during childhood. It is an attractive alternative
β-adrenoceptor blocking agent for the management of pediatric arrhythmias. 相似文献
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A premature neonate with hydrops was born at 32 weeks of gestation after successful direct fetal amiodarone therapy via cordocentesis for incessant supraventricular tachycardia. After birth the tachycardia could not be controlled despite high doses of amiodarone and flecainide and the patient developed severe respiratory and circulatory failure. After 3 weeks, weighing 2 kg, he underwent successful and uncomplicated catheter ablation of a left free-wall accessory pathway using low-energy radiofrequency. Conclusion:radiofrequency catheter ablation is rarely used in neonates, but when used with caution may provide the optimal treatment. 相似文献
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目的 观察盐酸索他洛尔治疗CHD患儿术后室上性心动过速的疗效.方法 收集2005年9月至2012年3月首都医科大学附属北京安贞医院小儿心脏科行CHD手术治疗且术后发生室上性心动过速,并予盐酸索他洛尔片口服治疗的患儿21例.将患儿按照盐酸索他洛尔不同给药剂量分为3组,Ⅰ组≤0.30 mg/(kg·次),Ⅱ组0.31~0.80 mg/(kg·次),Ⅲ组0.81 ~2.00mg/(kg·次).比较各组显效率、给药前后不同时间点心率、收缩压、中心静脉压(CVP).观察是否发生心动过缓、QT间期延长、尖端扭转型室上性心动过速等恶性心律失常.结果 Ⅰ组、Ⅱ组和Ⅲ组显效率分别为16.7%、20.0%和100%.Ⅲ组显效率最高,3组显效率比较差异有统计学意义(P<0.05).Ⅰ组、Ⅱ组和Ⅲ组心率下降最大比例分别为17.2%、21.5%和34.9%,用药2、4、8、12 hⅢ组的心率均低于Ⅰ组和Ⅱ组,但仅术后8h心率差异有统计学意义(P<0.05).3组用药后不同时间点收缩压及CVP变化均不明显,差异均无统计学意义(P均>0.05).全组病例未发生心动过缓、QT间期延长、尖端扭转型室上性心动过速等恶性心律失常.结论 盐酸索他洛尔用于CHD术后室上性心动过速的治疗安全有效,不良反应小.剂量越大疗效越显著. 相似文献