15例儿童心动过速性心肌病的诊疗体会

目的:探讨儿童完全性心动过速性心肌病(pTIC)的临床特点、治疗及预后。方法:回顾分析2009年1月至2016年10月安徽省儿童医院心内科收治的15例完全性心动过速性心肌病患儿的临床表现、心功能、心电图、心脏彩超的特点,观察心律失常控制后的心室率、心脏左室内径大小及心功能恢复情况。结果:15例pTIC患儿以室上性快速心律失常多见(14例),10例单纯药物治疗,3例接受射频消融转为窦性心律,2例失访。随访半年至3年与治疗前比较心室率明显下降(116±27)次/分vs.(189±28)次/分]、NT-proBNP降低(404±355)pg/mL vs.(6280±3155)pg/mL]、心脏左室舒张末内径变小(3.12±0.48)cm vs.(3.69±0.70)cm]、左室射血分数升高(57.9±9.3)%vs.(42.2±9.5)%]、改良ROSS评分下降1(0-5)分vs.7(4-10)分]。结论:儿童pTIC由各种快速心律失常引起,心脏扩大和心功能障碍可完全恢复,早期识别、有效治疗的儿童pTIC长期预后良好。

Clinical Diagnosis and Treatment Experience of 15 Cases of Children with Tachycardia-Induced Cardiomyopathy

ABSTRACT Objective: To analyze the clinical features, efficiency of anti-arrhythmic medications and prognosis of children with tachycardia-induced cardiomyopathy (pTIC). Methods: The clinical data of 15 cases of children with pTIC admitted in the children''s hospital of Anhui province from January 2009 to October 2016 were retrospectively analyzed and followed up. The clinical features, cardiac function, electrocardiographic and echocardiographic evaluation were analyzed. The ventricular rate, the size of the left ventricular diameter and the recovery of cardiac function were observed after cardiac arrhythmia was controlled. Results: The supraventricular arrhythmia was the commonest arrhythmia in 15 cases of pTIC(14 cases), there were 10 cases of pure drug therapy, 3 patients received radiofrequency ablation, and 2 cases were lost. The ventricular heart rates of was decreased compared with those of pretherapy (116±27)bpm vs. (189±28)bpm], NT-proBNP was decreased(404±355)pg/mL vs. (6280±3155)pg/mL], left ventricular end-diastolic diameter was shrunken (3.12±0.48)cm vs. (3.69±0.70)cm], ejection fraction was increased(57.9±9.3)% vs. (42.2±9.5)%], and Modified Ross score as decreased 1 vs. 7] after six months to 3 years. Conclusion: PTIC was caused by a variety of rapid arrhythmias. Heart enlargement and cardiac dysfunction could be fully restored. Children given early recognition and effective treatment had better prognosis.