儿童T波电交替的临床研究

目的 探讨T波电交替(T-wave alternans,TWA)的病因及预防恶性室性心律失常和心源性猝死的方法.方法 回顾性分析6例心电图TWA阳性患儿诊治的过程.例1为急性重症心肌炎;例2为特发性左室室性心动过速患儿因长时间大剂量使用乙胺碘呋酮后,导致获得性长QT综合征;例3为先天性长QT综合征;例4为先天性心脏病主动脉缩窄纠治术后心肌梗死;例5、例6为心率增快的先天性重度主动脉瓣狭窄.结果 6例均出现心电图TWA,其中5例即时或几小时后出现室性心动过速.2例通过治疗,TWA消失,未出现室性心动过速;另外4例未积极预防室性心动过速的发生而死亡.结论 TWA是室性心动过速、心室颤动及心源性猝死的先兆,应引起临床重视;对于TWA阳性患儿,除了明确病因,积极治疗原发病外,应高度警惕恶性室性心律失常的发生,另外积极预防TWA的出现也尤为重要.

A clinical study of T-wave alternans in pediatric patients

Objective To investigate the cause of T-wave altemans in pediatric patients, and prevent malignant ventricular arrhythmia and sudden cardiac death. Methods We retrospectively analyzed the treating process of 6 pediatric patients with T-wave alternans. Case 1 was a child with acute serious myocarditis. Case 2 was a child with idiopathic left ventricular tachycardia, and had acquired long-QT syndrome after treated with large dose of amiodarone for a long time by unclear diagnosis. Case 3 had congenital long-QT syndrome. Case 4 was a child with myocardial infarction after correction of coarctation of aorta for 5 months. Case 5 and case 6 were children who hade increasing heart rate with severe congenital stenosis of aortic valve. Results All of 6 cases occurred T-wave altemans, and 5 of them occurred malignant ventricular arrhythmia instantly or after several hours. In 2 cases, T-wave altemans disappeared and malignant ventricular arrhythmia did not occurred through prevention and treatment. The other 4 cases died without active prevention for malignant ventricular arrhythmia. Conclusion T-wave alternans is presymptom of malignant ventricular arrhythmia and sudden cardiac death. We should take notice of occurrence of malignant ventricular arrhythmia in pediatric patients with T-wave altemans and diagnosing and treating correctly for primary disease. It is of great importance to prevent occurrence of T-wave altemans.