今日の臨床サポート

頻脈・不整脈(小児科)

著者: 朝海廣子 Sydney Children’s Hospital Network, Australia

監修: 五十嵐隆 国立成育医療研究センター

著者校正/監修レビュー済:2021/08/25
患者向け説明資料

概要・推奨   

  1. 心室性期外収縮では12誘導心電図のほかホルター心電図で頻度や多形性の有無、運動負荷試験で運動時に抑制されるかを検査することが推奨される(推奨度2)
  1. 頻拍の場合、12誘導心電図のほかホルター心電図、運動負荷心電図、イベントリコーダー等で頻拍発作時の心電図記録を試みることが推奨される(推奨度2)
  1. 徐脈の場合、12誘導心電図のほか、症状に応じてホルター心電図や運動負荷心電図を行うことが推奨される(推奨度2) 
  1. 閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲覧にはご契約が必要となります。閲
薬剤監修について:
オーダー内の薬剤用量は日本医科大学付属病院 薬剤部 部長 伊勢雄也 以下、林太祐、渡邉裕次、井ノ口岳洋、梅田将光による疑義照会のプロセスを実施、疑義照会の対象については著者の方による再確認を実施しております。
※薬剤中分類、用法、同効薬、診療報酬は、エルゼビアが独自に作成した薬剤情報であり、
著者により作成された情報ではありません。
尚、用法は添付文書より、同効薬は、薬剤師監修のもとで作成しております。
※薬剤情報の(適外/適内/⽤量内/⽤量外/㊜)等の表記は、エルゼビアジャパン編集部によって記載日時にレセプトチェックソフトなどで確認し作成しております。ただし、これらの記載は、実際の保険適用の査定において保険適用及び保険適用外と判断されることを保証するものではありません。また、検査薬、輸液、血液製剤、全身麻酔薬、抗癌剤等の薬剤は保険適用の記載の一部を割愛させていただいています。
(詳細はこちらを参照)
著者のCOI(Conflicts of Interest)開示:
朝海廣子 : 特に申告事項無し[2021年]
監修:五十嵐隆 : 特に申告事項無し[2021年]

改訂のポイント:
  1. 定期レビューを行った

病態・疫学・診察

疫学情報・病態・注意事項  
  1. 最も遭遇する不整脈は心室性期外収縮であり、学校検診や診察上の心音の不整で指摘を受けることが多い。ほとんどのものが治療の必要がなく、経過観察となる。
  1. 器質的心疾患の鑑別と家族歴の聴取は重要である。
  1. 運動にて増悪する不整脈の鑑別が重要であり、必要であれば運動負荷検査を行う。
  1. 徐脈治療にて重要な点は、症状の有無である。ホルター心電図での評価も有用である。
  1. 頻脈性不整脈は、発作状況、年齢に応じてカテーテルアブレーションを考慮する。
  1. 抗不整脈薬、抗アレルギー薬、抗菌薬(マクロライド系や抗真菌薬)、向精神薬、抗うつ薬などの薬剤によりQT延長を来す例があるため、QT延長が疑われる場合には、薬剤歴にてそれらの内服の有無についても確認することが望ましい。
 
 
 
  1. 頻度の高い心室性期外収縮は、左機能低下を来す可能性がある。(参考文献:[1]
  1. 頻度の高いもの(1日の20%以上)、coupling intervalが短いものでは、心機能低下の可能性がある。
  1. 追記:成人の報告では、心機能へ影響する期外収縮の頻度として、1日1万回以上あるいは20%以上などいくつかの報告がある。
問診・診察のポイント  
  1. 自覚症状の有無や失神の有無の確認や、突然死および不整脈の家族歴の聴取を行う。特に失神例では、QT延長症候群を始めとした遺伝性不整脈疾患の鑑別のため家族歴の聴取は必須である。

これより先の閲覧には個人契約のトライアルまたはお申込みが必要です。

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文献 

著者: Yiping Sun, Nico A Blom, Yonghui Yu, Peiran Ma, Yi Wang, Xiuzhen Han, Cees A Swenne, Ernst E van der Wall
雑誌名: Int J Cardiovasc Imaging. 2003 Aug;19(4):295-9.
Abstract/Text BACKGROUND: Isolated monomorphic premature ventricular contractions (PVCs) are not uncommon in the pediatric population. The degree of cardiac dysfunction caused by PVCs in children without structural heart disease is unknown.
PURPOSE: To investigate the influence of PVCs on echocardiographic left ventricular (LV) systolic function in children without structural heart disease.
METHODS: Forty asymptomatic children with isolated monomorphic PVCs without structural heart disease were selected. The median age was 6 years, range of 3-12 years. The following subgroups were compared: frequent vs. infrequent PVCs (> or < or = 10/min); short vs. long coupling interval (RR'/RR ratio < or = or > 0.6); and short vs. long QT interval (QT < or = or > 400 ms). Using echocardiography the left ventricular ejection fraction (LVEF in percentage) and cardiac index (CI in L/min/m2) were measured for both normal sinus beats (SB-LVEF and CI), PVCs (PVC-LVEF and CI) and the average LVEF and CI were calculated. All values were expressed as means +/- SD.
RESULTS: In all children LV dimensions and the SB-LVEF and CI were within normal limits. The PVC-LVEF (48 +/- 5) and PVC-CI (1.57 +/- 0.19) were significantly decreased and the average CI was 2.41 +/- 0.29. In 27 pts with > 10 PVCs/min the average LVEF and CI decreased to 53 +/- 5 and 2.08 +/- 0.24 respectively. In 16 pts with PVCs and a short coupling interval (RR'/RR < or = 0.6) the PVC-LVEF and PVC-CI was 43 +/- 0.03 and 1.50 +/- 0.14, which was significantly lower than in 24 pts with a long coupling interval (58 +/- 4, 1.88 +/- 0.11). In 11 pts with a prolonged QT interval (> 400 ms) the PVC-LVEF and PVC-CI was significantly lower than in the 29 children with a shorter QT interval, 41 +/- 5 vs. 55 +/- 4 and 1.46 +/- 0.13 vs. 1.86 +/- 0.15 respectively (all p < 0.01).
CONCLUSION: In asymptomatic children with isolated monomorphic PVCs the average ejection fraction and cardiac output is markedly reduced if PVCs are frequent (> 10/min), have a short coupling interval or a prolonged QT interval.

PMID 14598897  Int J Cardiovasc Imaging. 2003 Aug;19(4):295-9.
著者: P J Schwartz, M Stramba-Badiale, A Segantini, P Austoni, G Bosi, R Giorgetti, F Grancini, E D Marni, F Perticone, D Rosti, P Salice
雑誌名: N Engl J Med. 1998 Jun 11;338(24):1709-14. doi: 10.1056/NEJM199806113382401.
Abstract/Text BACKGROUND: The sudden infant death syndrome (SIDS) is multifactorial in origin, but its causes remain unknown. We previously proposed that prolongation of the QT interval on the electrocardiogram, possibly resulting from a developmental abnormality in cardiac sympathetic innervation, may increase the risk of life-threatening ventricular arrhythmias and contribute to this devastating disorder. We prospectively tested this hypothesis.
METHODS: Between 1976 and 1994, we recorded electrocardiograms on the third or fourth day of life in 34,442 newborns and followed them prospectively for one year. The QT interval was analyzed with and without correction for the heart rate.
RESULTS: One-year follow-up data were available for 33,034 of the infants. There were 34 deaths, of which 24 were due to SIDS. The infants who died of SIDS had a longer corrected QT interval (QTc) than did the survivors (mean [+/-SD], 435+/-45 vs. 400+/-20 msec, P<0.01) and the infants who died from causes other than SIDS (393+/-24 msec, P<0.05). Moreover, 12 of the 24 SIDS victims but none of the other infants had a prolonged QTc (defined as a QTc greater than 440 msec). When the absolute QT interval was determined for similar cardiac-cycle lengths, it was found that 12 of the 24 infants who died of SIDS had a QT value exceeding the 97.5th percentile for the study group as a whole. The odds ratio for SIDS in infants with a prolonged QTc was 41.3 (95 percent confidence interval, 17.3 to 98.4).
CONCLUSIONS: Prolongation of the QT interval in the first week of life is strongly associated with SIDS. Neonatal electrocardiographic screening may permit the early identification of a substantial percentage of infants at risk for SIDS, and the institution of preventive measures may therefore be possible.

PMID 9624190  N Engl J Med. 1998 Jun 11;338(24):1709-14. doi: 10.1056・・・
著者: Marianne Arnestad, Lia Crotti, Torleiv O Rognum, Roberto Insolia, Matteo Pedrazzini, Chiara Ferrandi, Ashild Vege, Dao W Wang, Troy E Rhodes, Alfred L George, Peter J Schwartz
雑誌名: Circulation. 2007 Jan 23;115(3):361-7. doi: 10.1161/CIRCULATIONAHA.106.658021. Epub 2007 Jan 8.
Abstract/Text BACKGROUND: The hypothesis that some cases of sudden infant death syndrome (SIDS) could be caused by long-QT syndrome (LQTS) has been supported by molecular studies. However, there are inadequate data regarding the true prevalence of mutations in arrhythmia-susceptibility genes among SIDS cases. Given the importance and potential implications of these observations, we performed a study to more accurately quantify the contribution to SIDS of LQTS gene mutations and rare variants.
METHODS AND RESULTS: Molecular screening of 7 genes (KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, KCNJ2, CAV3) associated with LQTS was performed with denaturing high-performance liquid chromatography and nucleotide sequencing of genomic DNA from 201 cases diagnosed as SIDS according to the Nordic Criteria, and from 182 infant and adult controls. All SIDS and control cases originated from the same regions in Norway. Genetic analysis was blinded to diagnosis. Mutations and rare variants were found in 26 of 201 cases (12.9%). On the basis of their functional effect, however, we considered 8 mutations and 7 rare variants found in 19 of 201 cases as likely contributors to sudden death (9.5%; 95% CI, 5.8 to 14.4%).
CONCLUSIONS: We demonstrated that 9.5% of cases diagnosed as SIDS carry functionally significant genetic variants in LQTS genes. The present study demonstrates that sudden arrhythmic death is an important contributor to SIDS. As these variants likely modify ventricular repolarization and QT interval duration, our results support the debated concept that an ECG would probably identify most infants at risk for sudden death due to LQTS either in infancy or later on in life.

PMID 17210839  Circulation. 2007 Jan 23;115(3):361-7. doi: 10.1161/CIR・・・
著者: Tesshu Otagiri, Kazuki Kijima, Motoki Osawa, Kuniaki Ishii, Naomasa Makita, Ryoji Matoba, Kazuo Umetsu, Kiyoshi Hayasaka
雑誌名: Pediatr Res. 2008 Nov;64(5):482-7. doi: 10.1203/PDR.0b013e3181841eca.
Abstract/Text Sudden infant death syndrome (SIDS) is multifactorial and may result from the interaction of a number of environmental, genetic, and developmental factors. We studied three major genes causing long QT syndrome in 42 Japanese SIDS victims and found five mutations, KCNQ1-K598R, KCNH2-T895M, SCN5A-F532C, SCN5A-G1084S, and SCN5A-F1705S, in four cases; one case had both KCNH2-T895M and SCN5A-G1084S. All mutations were novel except for SCN5A-F532C, which was previously detected in an arrhythmic patient. Heterologous expression study revealed significant changes in channel properties of KCNH2-T895M, SCN5A-G1084S, and SCN5A-F1705S, but did not in KCNQ1-K598R and SCN5A-F532C. Our data suggests that nearly 10% of SIDS victims in Japan have mutations of the cardiac ion channel genes similar to in other countries.

PMID 18596570  Pediatr Res. 2008 Nov;64(5):482-7. doi: 10.1203/PDR.0b0・・・
著者: Anton Lishmanov, Priya Chockalingam, Annamalai Senthilkumar, Anand Chockalingam
雑誌名: Congest Heart Fail. 2010 May-Jun;16(3):122-6. doi: 10.1111/j.1751-7133.2010.00147.x.
Abstract/Text Tachycardia-induced cardiomyopathy is caused by sustained rapid ventricular rates and is one of the well-known forms of reversible myocardial dysfunction. The diagnosis is usually made retrospectively after marked improvement in systolic function is noted following control of the heart rate. Physicians should be aware that patients with seemingly idiopathic systolic dysfunction may have tachycardia-induced cardiomyopathy and that controlling the heart rate may result in improvement or even complete restoration of systolic function.

(c) 2010 Wiley Periodicals, Inc.
PMID 20557332  Congest Heart Fail. 2010 May-Jun;16(3):122-6. doi: 10.1・・・
著者: G Fenelon, W Wijns, E Andries, P Brugada
雑誌名: Pacing Clin Electrophysiol. 1996 Jan;19(1):95-106.
Abstract/Text
PMID 8848384  Pacing Clin Electrophysiol. 1996 Jan;19(1):95-106.
著者: Jeremy P Moore, Payal A Patel, Kevin M Shannon, Erin L Albers, Jack C Salerno, Maya A Stein, Elizabeth A Stephenson, Shaun Mohan, Maully J Shah, Hiroko Asakai, Andreas Pflaumer, Richard J Czosek, Melanie D Everitt, Jason M Garnreiter, Anthony C McCanta, Andrew L Papez, Carolina Escudero, Shubhayan Sanatani, Nicole B Cain, Prince J Kannankeril, Andras Bratincsak, Ravi Mandapati, Jennifer N A Silva, Kenneth R Knecht, Seshadri Balaji
雑誌名: Heart Rhythm. 2014 Jul;11(7):1163-9. doi: 10.1016/j.hrthm.2014.04.023. Epub 2014 Apr 19.
Abstract/Text BACKGROUND: Tachycardia-induced cardiomyopathy (TIC) carries significant risk of morbidity and mortality, although full recovery is possible. Little is known about the myocardial recovery pattern.
OBJECTIVE: The purpose of this study was to determine the time course and predictors of myocardial recovery in pediatric TIC.
METHODS: An international multicenter study of pediatric TIC was conducted. Children ≤18 years with incessant tachyarrhythmia, cardiac dysfunction (left ventricular ejection fraction [LVEF] <50%), and left ventricular (LV) dilation (left ventricular end-diastolic dimension [LVEDD] z-score ≥2) were included. Children with congenital heart disease or suspected primary cardiomyopathy were excluded. Primary end-points were time to LV systolic functional recovery (LVEF ≥55%) and normal LV size (LVEDD z-score <2).
RESULTS: Eighty-one children from 17 centers met inclusion criteria: median age 4.0 years (range 0.0-17.5 years) and baseline LVEF 28% (interquartile range 19-39). The most common arrhythmias were ectopic atrial tachycardia (59%), permanent junctional reciprocating tachycardia (23%), and ventricular tachycardia (7%). Thirteen required extracorporeal membrane oxygenation (n = 11) or ventricular assist device (n = 2) support. Median time to recovery was 51 days for LVEF and 71 days for LVEDD. Two (4%) underwent heart transplantation, and 1 died (1%). Multivariate predictors of LV systolic functional recovery were age (hazard ratio [HR] 0.61, P = .040), standardized tachycardia rate (HR 1.16, P = .015), mechanical circulatory support (HR 2.61, P = .044), and LVEF (HR 1.33 per 10% increase, p=0.005). For normalization of LV size, only baseline LVEDD (HR 0.86, P = .008) was predictive.
CONCLUSION: Pediatric TIC resolves in a predictable fashion. Factors associated with faster recovery include younger age, higher presenting heart rate, use of mechanical circulatory support, and higher LVEF, whereas only smaller baseline LV size predicts reverse remodeling. This knowledge may be useful for clinical evaluation and follow-up of affected children.

Published by Elsevier Inc.
PMID 24751393  Heart Rhythm. 2014 Jul;11(7):1163-9. doi: 10.1016/j.hrt・・・
著者: J C Perry, A Garson
雑誌名: J Am Coll Cardiol. 1990 Nov;16(5):1215-20.
Abstract/Text UNLABELLED: The clinical course of 140 patients with Wolff-Parkinson-White syndrome who had their initial episode of supraventricular tachycardia before 18 years of age was reviewed. Among those whose tachycardia began at age 0 to 2 months, it disappeared in 93% and persisted in 7%. In 31%, it disappeared and reappeared at an average age of 8 years. Among patients whose tachycardia was present after age 5 years, it was persistent in 78% at a mean follow-up period of 7 years. Accessory connection location was mapped by electrophysiologic study in 87 patients and estimated by electrocardiography in 53 patients. There were no differences in tachycardia onset or recurrence based on accessory connection location. Congenital heart defects were present in 37% of all patients, 23% of whom had Ebstein's anomaly. Among all patients who underwent cardiac catheterization, 63% of those with a congenital heart defect had a rightsided accessory connection, whereas 61% of patients with a normal heart had a left-sided connection (p less than 0.01). Multiple accessory connections were found in 12% of patients with a congenital heart defect compared with 6% of those without such a defect.
IN CONCLUSION: 1) supraventricular tachycardia due to Wolff-Parkinson-White syndrome that begins in infancy may disappear, but it frequently recurs in later childhood; 2) if tachycardia is present after age 5 years, it persists in greater than 75% of patients; and 3) the location of the accessory connection does not affect the clinical course of tachycardia in children with Wolff-Parkinson-White syndrome.

PMID 2229769  J Am Coll Cardiol. 1990 Nov;16(5):1215-20.
著者: Richard A Friedman, Edward P Walsh, Michael J Silka, Hugh Calkins, William G Stevenson, Larry A Rhodes, Barbara J Deal, Grace S Wolff, David R Demaso, Debra Hanisch, George F Van Hare
雑誌名: Pacing Clin Electrophysiol. 2002 Jun;25(6):1000-17.
Abstract/Text
PMID 12137336  Pacing Clin Electrophysiol. 2002 Jun;25(6):1000-17.
著者: Pediatric and Congenital Electrophysiology Society (PACES), Heart Rhythm Society (HRS), American College of Cardiology Foundation (ACCF), American Heart Association (AHA), American Academy of Pediatrics (AAP), Canadian Heart Rhythm Society (CHRS), Mitchell I Cohen, John K Triedman, Bryan C Cannon, Andrew M Davis, Fabrizio Drago, Jan Janousek, George J Klein, Ian H Law, Fred J Morady, Thomas Paul, James C Perry, Shubhayan Sanatani, Ronn E Tanel
雑誌名: Heart Rhythm. 2012 Jun;9(6):1006-24. doi: 10.1016/j.hrthm.2012.03.050. Epub 2012 May 10.
Abstract/Text
PMID 22579340  Heart Rhythm. 2012 Jun;9(6):1006-24. doi: 10.1016/j.hrt・・・
著者: Ken-Ichi Kurosaki, Aya Miyazaki, Ken Watanabe, Shigeyuki Echigo
雑誌名: Circ J. 2008 Jan;72(1):81-7.
Abstract/Text BACKGROUND: Few investigators have examined the outcome of patients with isolated congenital complete atrioventricular block (CCAVB) paced from the neonatal period. The present study follows the clinical course and describes the outcome of patients who have been paced with CCAVB since they were neonates.
METHODS AND RESULTS: The medical records of 20 patients with CCAVB paced as neonates between 1981 and 2006 were retrospectively studied and reviewed; 18 were diagnosed in utero and 2 at birth. SS-A antibodies were detected in 9 of 14 (64%) mothers tested. The median age at follow-up was 5.6 years (range, 2 days to 21.9 years). Three (15%) of the early neonates died and 3 (15%) died later: 2 from dilated cardiomyopathy (DCM) and 1 from pneumonia. The total mortality rate was 30%. The cumulative probability of survival at 10 years was 73%. Of the 14 survivors, 4 developed DCM, representing a total morbidity of 30%. The cumulative probability of freedom from DCM at 10 years was 59%.
CONCLUSIONS: Patients with CCAVB who undergo pacing as neonates have high mortality and high morbidity because of DCM. Left ventricular pacing or resynchronization can benefit patients who develop DCM and left ventricular epicardial pacing is recommended for neonates with CCAVB.

PMID 18159105  Circ J. 2008 Jan;72(1):81-7.
著者: Tchavdar Nikolov Shalganov, Dora Paprika, Radu Vatasescu, Attila Kardos, Attila Mihalcz, Laszlo Kornyei, Andras Szatmari, Tamas Szili-Torok
雑誌名: Cardiovasc Ultrasound. 2007 Mar 12;5:13. doi: 10.1186/1476-7120-5-13. Epub 2007 Mar 12.
Abstract/Text BACKGROUND: Chronic right ventricular apical pacing may have detrimental effect on left ventricular function and may promote to heart failure in adult patients with left ventricular dysfunction.
METHODS: A group of 99 pediatric patients with previously implanted pacemaker was studied retrospectively. Forty-three patients (21 males) had isolated congenital complete or advanced atrioventricular block. The remaining 56 patients (34 males) had pacing indication in the presence of structural heart disease. Thirty-two of them (21 males) had isolated structural heart disease and the remaining 24 (13 males) had complex congenital heart disease. Patients were followed up for an average of 53 +/- 41.4 months with 12-lead electrocardiogram and transthoracic echocardiography. Left ventricular shortening fraction was used as a marker of ventricular function. QRS duration was assessed using leads V5 or II on standard 12-lead electrocardiogram.
RESULTS: Left ventricular shortening fraction did not change significantly after pacemaker implantation compared to preimplant values overall and in subgroups. In patients with complex congenital heart malformations shortening fraction decreased significantly during the follow up period. (0.45 +/- 0.07 vs 0.35 +/- 0.06, p = 0.015). The correlation between the change in left ventricular shortening fraction and the mean increase of paced QRS duration was not significant. Six patients developed dilated cardiomyopathy, which was diagnosed 2 months to 9 years after pacemaker implantation.
CONCLUSION: Chronic right ventricular pacing in pediatric patients with or without structural heart disease does not necessarily result in decline of left ventricular function. In patients with complex congenital heart malformations left ventricular shortening fraction shows significant decrease.

PMID 17352821  Cardiovasc Ultrasound. 2007 Mar 12;5:13. doi: 10.1186/1・・・
著者: Irene E van Geldorp, Tammo Delhaas, Roman A Gebauer, Patrick Frias, Maren Tomaske, Mark K Friedberg, Svjetlana Tisma-Dupanovic, Jan Elders, Andreas Früh, Fulvio Gabbarini, Petr Kubus, Viera Illikova, Sabrina Tsao, Andreas Christian Blank, Anita Hiippala, Thierry Sluysmans, Peter Karpawich, Sally-Ann Clur, Xavier Ganame, Kathryn K Collins, Gisela Dann, Jean-Benoît Thambo, Conceição Trigo, Bert Nagel, John Papagiannis, Annette Rackowitz, Jan Marek, Jan-Hendrik Nürnberg, Ward Y Vanagt, Frits W Prinzen, Jan Janousek, Working Group for Cardiac Dysrhythmias and Electrophysiology of the Association for European Paediatric Cardiology
雑誌名: Heart. 2011 Dec;97(24):2051-5. doi: 10.1136/heartjnl-2011-300197. Epub 2011 Sep 14.
Abstract/Text BACKGROUND: Chronic right ventricular (RV) pacing is associated with deleterious effects on cardiac function.
OBJECTIVE: In an observational multicentre study in children with isolated atrioventricular (AV) block receiving chronic ventricular pacing, the importance of the ventricular pacing site on left ventricular (LV) function was investigated.
METHODS: Demographics, maternal autoantibody status and echocardiographic measurements on LV end-diastolic and end-systolic dimensions and volumes at age <18 years were retrospectively collected from patients undergoing chronic ventricular pacing (>1 year) for isolated AV block. LV fractional shortening (LVFS) and, if possible LV ejection fraction (LVEF) were calculated. Linear regression analyses were adjusted for patient characteristics.
RESULTS: From 27 centres, 297 children were included, in whom pacing was applied at the RV epicardium (RVepi, n = 147), RV endocardium (RVendo, n = 113) or LV epicardium (LVepi, n = 37). LVFS was significantly affected by pacing site (p = 0.001), and not by maternal autoantibody status (p = 0.266). LVFS in LVepi (39 ± 5%) was significantly higher than in RVendo (33 ± 7%, p < 0.001) and RVepi (35 ± 8%, p = 0.001; no significant difference between RV-paced groups, p = 0.275). Subnormal LVFS (LVFS < 28%) was seen in 16/113 (14%) RVendo-paced and 21/147 (14%) RVepi-paced children, while LVFS was normal (LVFS ≥ 28%) in all LVepi-paced children (p = 0.049). These results are supported by the findings for LVEF (n = 122): LVEF was <50% in 17/69 (25%) RVendo- and in 10/35 (29%) RVepi-paced patients, while LVEF was ≥ 50% in 17/18 (94%) LVepi-paced patients.
CONCLUSION: In children with isolated AV block, permanent ventricular pacing site is an important determinant of LV function, with LVFS being significantly higher with LV pacing than with RV pacing.

PMID 21917655  Heart. 2011 Dec;97(24):2051-5. doi: 10.1136/heartjnl-20・・・

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(※トライアルご登録は1名様につき、一度となります)


ご契約の場合はご招待された方だけのご優待特典があります。

以下の優待コードを入力いただくと、

契約期間が通常12ヵ月のところ、14ヵ月ご利用いただけます。

優待コード: (利用期限:まで)

ご契約はこちらから