The treatment of paroxysmal supraventricular tachycardia in children and the significance of myocardial damage markers / 中国小儿急救医学

ABSTRACT

Objective:To analyze the changes of myocardial damage markers during ventricular tachycardia (SVT) onset and efficacy of various therapeutic approaches.Methods:The clinical data of 256 children with SVT admitted to Beijing Children′s Hospital Affiliated to Capital Medical University from October 2018 to October 2019 were retrospectively analyzed.According to the age of onset, children were divided into groups of 0~3 years old, >3-6 years old, and >6 years old.According to the different heart rates at the time of attack, patients were divided into the groups of <180 times/min, 180~260 times /min, and >260 times /min.According to the treatment methods, children were divided into physical therapy group, drug therapy group and radiofrequency ablation group.Frequency of SVT attacks, heart rate at the onset, serum creatine kinase isoenzyme (CK-MB), troponin (cTn) I, and brain natiuretic peptide(BNP) were collected within 2 h after the onset stop.The recovery rate of each treatment group was counted.Results:Among the 256 cases, there were 135 males and 121 females, which aged from 1 month to 18 years, mean age was (10.2±2.2) years and SVT attacked from 1 to 8 times.The faster the heart rate during SVT attack, the higher CK-MB, cTnI and BNP ( P<0.05). The recovery rate was 27.6% in the mechanical stimulation group, 98.0% in the drug treatment group and 100% in the radiofrequency ablation group, respectively.Successful recovery rate was 47.2%(34 cases)with ATP, 71.7%(109 cases)with Propafenone, 67.3%(64 cases)with Cediland, 59.6%(31 cases)with Verapamil, 61.5%(24 cases)with Sotalol and 54.7%(29 cases)with Amiodarone.Eithty-two cases were successfully converted by two drugs(32.7%) and 38 cases were successfully converted by three drugs(15.1%). Conclusion:When SVT attacks, most children have myocardial damage.The faster the heart rate, the greater the damage in the heart muscle; The treatment of SVT in children should still be the first choice of physical therapy in older children, and if it is not effective, drug therapy should be selected.Radiofrequency ablation is the most effective method to cure tachyarrhythmia.