经食管心房调搏在儿童不明原因心动过速中的应用

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。     

食道心房调搏在小儿室上性心动过速的临床应用

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。     

小儿室上性心动过速的心内电生理研究及射频消蚀治疗

应用心内电生理检查７８例室上性心动过速（ＳＶＴ）患儿，以探讨ＳＶＴ在小儿的发生机制和定位，并与成人相比较；同时对其中７５例进行了射频消蚀治疗。结果显示房室折返５９例（７６％），房室结折返１６例（２０％），自律性房性心动过速１例（１％），心房扑动２例（３％）。５９例房室折返中，显性预激４０例，隐匿性预激１９例。除２例心房扑动和１例自律性房性心动过速外，７５例患儿接受射频消蚀术治疗，７３例获成功。本研究提示，与成人相同，折返是小儿ＳＶＴ最常见的发生机制，以房室折返最为多见。房室折返和房室结折返性心动过速是射频消蚀术的良好适应证。     

食管心房调搏术在婴幼儿室上性心动过速中的应用

目的 探讨食管心房调搏术(TEAP)在婴幼儿室上性心动过速(SVT)诊断和治疗中的应用价值.方法　选取43例年龄<2岁的SVT婴幼儿.其中男23例,女20例;年龄(7.59±9.80)个月.采用TEAP检查,随后根据记录食管心电图进行分型诊断,明确为折返性心动过速、房性心动过速、房性扑动后立即进行超速抑制终止心动过速.并对其资料进行回顾性分析.结果　43例SVT婴幼儿经食管电生理检查,心室率为(233.31±46.79)次·min-1.其中29例次SVT中诊断为折返型SVT 23例次,房性动过速3例次,窦性心动过速并Ⅰ度房室传导阻滞(Ⅰ-AVB) 2例次,窦性心动过速1例次,房性扑动14例次.宽QRS心动过速2例,1例为Ⅰ-AVB并室内传导阻滞,另1例经随访确诊为交界性心动过速并室内传导阻滞.经TEAP成功转复率为83% (34/41例).结论　婴幼儿SVT往往伴较快心室率,如不及时救治极易产生不可逆的损害.TEAP的应用有助于婴幼儿SVT的诊断分型,而且其安全快速转复窦性心律的优点在婴幼儿心动过速的抢救中起重要作用.     

小儿室上性心动过速电生理与射频消融临床评估

目的 通过食道电牛理检查(transesophageal atrial pacing,TEAP)与心内电牛理(electrophysiology study of the heart,EPS)比较研究,探讨小儿室上性心动过速(supraventricular tachycardia,SVT)射频消融(radiofrequency catheter ablation,RFCA)术前TEAP对小儿SVT的发病机制、诊断价值及介入治疗适应证规范应用.方法 对1998年8月-2007年1月经RFCA治疗的SVT 34例患儿的TEAP及EPS资料进行对比分析.结果 SVT 34例,30例TEAP显示房室结折返性心动过速(atrioventricular nodal reentrant tachycardia,AVNRT)5例,房室折返性心动过速(atrioventricular reentrant tachyeardia,AVRT)25例,与EPS的诊断符合率为96.7%(29/30例);EPS诊断AVRT 30例,AVNRT 4例.成功消融32例,手术未见明显并发症.结论 TEAP与EPS检查结果符合率较高,可作为快速性心律失常的初步诊断及定位,为选择EPS及RFCA术指征重要辅助手段;RFCA根治小儿室上性心动过速疗效肯定,是小儿SVT安全可行的介入治疗方法.     

无创性电生理检查在儿童阵发性室上性心动过速诊断中的应用价值

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。     

小儿室上性心动过速87例临床分析和治疗药物选择

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。     

食管心房调搏术在新生儿快速型心律失常的应用价值

目的 探讨食管心房调搏术（TEAP）在新生儿快速型心律失常的应用价值。方法 收集进行TEAP电生理检查或复律的26例快速型心律失常新生儿的临床资料。结果 15例（58%）确诊为房室折返性心动过速,3例（12%）为窦性心动过速,3例（12%）为室速,2例（8%）为慢快型房室结折返性心动过速,2例（8%）为房性心动过速,1例（4%）为窦速伴心室预激。22例患儿进行了超速抑制,除2例房速和2例室速未能恢复窦律外,18例新生儿均成功复律。结论 TEAP能帮助诊断新生儿快速型心律失常,且能用于复律。     

程控刺激在小儿室上性心动过速诊断中的临床价值

目的：评价程控刺激（ＰＥＳ）在儿科临床应用的价值。方法：通过ＰＥＳ检测室上性心动过速（ＰＳＶＴ）１６０例。结果：①１６０例ＰＳＶＴ分别由：房室折返性心动过速（ＡＶＲＴ）７８例（４８７５％）、房室结折返性心动过速（ＡＶＮＲＴ）６９例（４３１２５％）、复合型折返性心动过速６例（３５７５％）和房内折返性心动过速（ＩＡＲＴ）７例（４３７５％）构成；②ＰＥＳ能快速鉴别各类型ＰＳＶＴ，并了解其形成机理及折返途径；③２０例顺向性房室折返性心动过速患儿静脉推注心律平后经ＰＥＳ检测有１６例不再诱发心动过速，其用药后的旁道前传有效不应期（ＡＰＥＲＰ）有显著延长（Ｐ＜００１）。结论：ＰＥＳ是目前儿科临床诊断ＰＳＶＴ颇有价值的检测手段     

经食管心房调搏在儿童阵发性室上性心动过速机制研究中的价值

目的探讨经食管心房调搏(TEAP)在儿童阵发性室上性心动过速(PSVT)机制研究中的价值。方法回顾性分析2008年1月至2013年12月行TEAP检查且后期行射频消融术(RFCA)的50例PSVT患者的电生理资料。结果以经心内电生理检查(IEPS)为诊断金标准,TEAP对房室结折返性心动过速(AVNRT)、左侧房室旁道(LAP)、右侧房室旁道(RAP)的灵敏度分别为92.9%、83.1%、90%,特异度为86.4%、100%、95%,准确性为90%、96%和94%。TEAP对AVNRT诊断符合率为92.9%(26/28),其中对慢快型AVNRT的诊断符合率为100%,而2例快慢型的AVNRT均被误诊为房室折返性心动过速(AVRT)。TEAP对AVRT诊断的符合率为86.4%(19/22),3例被诊断为慢快型的AVNRT。结论 TEAP对儿童PSVT发生机制的判定及初步定位具有很好的临床实用价值,但对少数PSVT发生机制的判定具有一定的局限性。     

Impact of Transesophageal Electrophysiologic Study to Elucidate the Mechanism of Arrhythmia on Children With Supraventricular Tachycardia and No Preexcitation

An electrophysiologic study (EPS) of children and teenagers with paroxysmal supraventricular tachycardia (SVT) and normal electrocardiography (ECG) in sinus rhythm was evaluated. Generally, EPS is performed only before paroxysmal SVT ablation in these patients. In this study, 140 patients (mean age, 15 ± 3 years) with normal ECG in sinus rhythm were studied for SVT by a transesophageal route in baseline state and after isoproterenol. Idiopathic left or right ventricular tachycardia was diagnosed in four patients (3 %). Anterograde conduction over an atrioventricular (AV) left lateral (n = 10) or septal (n = 9) accessory pathway (AP) was noted in 19 patients (13.5 %) at atrial pacing. Orthodromic AV reentrant tachycardia (AVRT) was induced in these children. Five of the patients had a high rate conducted over AP (>240 bpm in baseline state or >290 bpm after isoproterenol). Two of the patients (a 10-year-old girl with well-tolerated SVT and a 17-year-old with syncope-related SVT) had the criteria for a malignant form with the induction of atrial fibrillation conducted over AP at a rate exceeding 290 bpm in baseline state. Of the 140 patients, 74 (53 %) had typical AV node reentrant tachycardia (AVNRT), nine had atypical AVNRT (6 %), 1 had atrial tachycardia (0.7 %), and 33 (23.5 %) had AVRT related to a concealed AP with only retrograde conduction. Electrophysiologic study is recommended for children with paroxysmal SVT and normal ECG in sinus rhythm. The data are helpful for guiding the treatment. Ventricular tachycardia or atrial tachycardia can be misdiagnosed. Masked preexcitation syndrome with anterograde conduction through AP was present in 13.5 % of the patients, and 1.4 % had a malignant preexcitation syndrome.     

小儿快速型心律失常240例临床分析

目的 探讨小儿不同类型心动过速的构成比、相应的临床特点和体表心电图（ＥＣＧ）特征。方法 对１９８５年３月￣１９９９年４月经我院心内电生理检查确诊为快速型心律失常的２４０例患儿进行分析,其中２２９例经射频消蚀证实。结果 （１）２４０例患儿中,２１５例为室上性心动过速（ＳＶＴ）;２５例为特发性室性心动过速（ＩＶＴ）。２１５例ＳＶＴ中,１６４例为旁道参与的房室折返性心动过速（ＡＶＲＴ）,其中显性旁道１０     

Ventricular fibrillation during transesophageal atrial pacing in an infant with Wolff-Parkinson-White syndrome

Summary A complication of transesophageal atrial pacing in an infant with Wolff-Parkinson-White syndrome (WPW) is reported. A newborn infant born with fetal hydrops had recurrent supraventricular tachycardia (SVT) that required repeated successful conversion by transesophageal atrial pacing. Because of secondary left ventricular dysfunction, digoxin was administered. During repeat transesophageal atrial pacing for recurrent SVT, ventricular fibrillation occurred. Although it is unclear which of several possible contributing factors was responsible for the ventricular fibrillation, recommendations are appropriate to minimize the risk in infants with WPW.     

Tachykarde Herzrhythmusstörungen im Kindes- und Jugendalter

Paroxysmal supraventricular tachycardia (SVT) is the most common type of tachyarrhythmia occurring with an incidence of 0.1–0.4%. The occurrence of ventricular tachycardia is significantly lower in children and adults. The most frequent types of SVT in children are atrioventricular reentry tachycardia (AVRT) mediated by an accessory pathway and AV-nodal reentry tachycardia (AVNRT) using fibres with different conduction capacities (dual physiology of the AV-node). Both types can be successfully terminated with adenosine which selectively blocks conduction through the AV-node. Long-term pharmacological therapy represents one therapeutic option for recurrent episodes of SVT but it is increasingly being replaced by radiofrequency catheter ablation, which represents a curative treatment of SVT with success rates between 86% and 97%, especially when applied in children older than 5 years. Thus, long-term management of children with tachyarrhythmias should include early contact with pediatric electrophysiological centres.     

Supraventricular tachycardia in the neonate and infant

Supraventricular tachycardia (SVT) is the most common sustained arrhythmia to present in the neonatal and infancy age group. Predisposing factors (congenital heart disease, drug administration, illness and fever) occur only in 15% of infants. The presentation of SVT in the neonate is frequently subtle, and may include pallor, cyanosis, restlessness, irritability, feeding difficulty, tachypnea, diaphoresis and grunting. Congestive heart failure is more common in infants under 4 months of age (35% incidence). Age-related differences in the distribution of SVT mechanisms occur in different age groups. In infants under 1 year of age, the mechanisms underlying SVT are atrial tachycardia (15%), AV nodal re-entry tachycardia (5%), and AV reciprocating tachycardia (80%). Options for acute management include: use of the diving reflex, intravenous adenosine, transesophageal pacing, and cardioversion. Intravenous administration of verapamil should be avoided. Data regarding freedom from recurrence of untreated SVT in the first year of life are limited, and may be in the range of 25-60%. Chronic therapy with digoxin, beta-blockers, flecainide, sotalol and amiodarone has proved effective in controlling recurrent episodes of SVT. Radiofrequency ablation can be employed successfully in medically refractory cases, but should be avoided in this age group (increased complication rate).     

Emergency department management of the pediatric patient with supraventricular tachycardia

Supraventricular tachycardia (SVT) is the most common tachyarrhythmia that necessitates treatment in children. It is characterized by a rapid and regular heart rate, which generally exceeds 180 beats per minute in children and 220 beats per minute in adolescents. Supraventricular tachycardia results from conduction of electrical impulses along an accessory connection from the atrium to the ventricle (atrioventricular reentry tachycardias: orthodromic or antidromic) or conduction within the atrioventricular node (atrioventricular node reentry tachycardia). Emergency department management of SVT depends on the patient's clinical status. Treatment of a stable patient with SVT includes vagal maneuvers and adenosine, whereas treatment of an unstable patient requires synchronized cardioversion. This article presents an overview of the etiology, pathophysiology, and clinical presentation of SVT and discusses the emergency department management of an infant or child with SVT.     

Pathogenesis of various types of tachycardia in childhood

As many as 33 children with different patterns of tachyarrhythmia were subjected to transesophageal pacing of the left atrium. Thi incidence of the orthodromal pattern of reciprocal AV-tachycardia was the highest (10 patients); antidromal reciprocal AV-tachycardia was only noted in 1 patient. Four patients turned out to have latent Kent's bundle which provoked the development of tachycardia attacks. The slow-fast pattern was revealed in both cases of nodal tachycardia. Among atrial tachycardias, monofocal automatic one was encountered most frequently (9 patients) and only one patient was diagnosed to suffer from reciprocal atrial tachycardia. The determination of the pathogenesis of tachycardia in children with the WPW syndrome is of importance for solving the problem of the successive medicamentous and non-pharmacological treatment character.