Special electrophysiological characteristics of pediatric idiopathic ventricular tachycardia

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• 作者：Shuenn-Nan Chiu^a ; ¹ ; Wei-Lun Wu^a ; ¹ ; Chun-Wei Lu^a ; ¹ ; Kun-Lang Wu^b ; ¹ ; Wei-Chieh Tseng^a ; ¹ ; Ming-Tai Lin^a ; ¹ ; Chien-Chih Chang^c ; ¹ ; Jou-Kou Wang^a ; ¹ ; Mei-Hwan Wu^a ; ¹ ; ^{wumh@ntuh.gov.tw}
• 关键词：Pediatric ; Ventricular tachycardia ; Left Purkinje ; Ablation ; Asian
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：595-601
• 全文大小：1078 K
• 卷排序：227

文摘

Idiopathic ventricular tachycardia (VT) is an important pediatric arrhythmia but relevant studies in Asian cohort are rare. We determined the electrophysiological characteristics and outcomes of this rhythm disturbance.MethodsFrom an institutional database, patients aged < 18 years without structural heart disease who have sustained monomorphic VT (longer than 30 s) during 1995–2016 were enrolled.ResultsWe enrolled 57 idiopathic VT patients (male:female = 31:26). The initial presentation included palpitation (64.9%) and shock (12.3%). The electrocardiography revealed relatively short QRS duration (123 ± 18 ms) and absence of ventriculoatrial dissociation in 33.3% of the patients, causing initial misdiagnosis in 29.8% of these patients. Patients with a VT onset age of < 10 years were more likely to have a left bundle branch block morphology (52.2% vs. 11.8%, p = 0.001) and spontaneous recovery than those with a VT onset age of ≥ 10 years. An electrophysiology study in 44 patients revealed that the most common arrhythmia focus was the left ventricular septal area (78%), called fascicular VT. Radiofrequency ablation showed a satisfactory success rate (90%) and fair recurrence rate (14.3%). Tachycardia-induced cardiomyopathy was noted in 14% of the VT patients and cardiac function returned to normal in 1–18 months (median, 3 months) after successful ablation.ConclusionsIn an Asian pediatric population, VT has distinct electrophysiological characteristics including dominant left ventricular origin, narrower QRS duration, and more symptomatic presentation. Transcatheter ablation is effective against VT, and the associated cardiomyopathy often resolves rapidly after successful ablation.