心动过速引起的心肌病:一个病例系列和文献回顾

Wisam Abozaid MD , Samantha Wong , Marc W. Deyell MD, FRCPC , Shubhayan Sanatani MD, FRCPC, FHRS , Sakethram Saravu Vijayashankar MD, MRCPCH
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摘要

心动过速性心肌病(tachy心动过速性心肌病),也称为心律失常性心肌病或过速性心肌病,是一种可逆性心衰形式,其特征是持续的心动过速和相关的心室功能障碍。TIC的特点是心肌损伤随着心律失常的消退而逆转。早期诊断TIC是必要的,因为治疗过程不同于其他原因或未知原因的心肌病。然而,区分TIC与继发于充血性心力衰竭引起的儿茶酚胺增加的心动过速是非常具有挑战性的。相对较少的儿科报道,在此我们介绍了文献中48例小儿TIC患者的病例系列(2014-2024)。我们还报告了在我们现场(加拿大温哥华BC儿童医院)看到的4例TIC病例。该病例系列的平均年龄为6.98±4.9岁。以异位性房性心动过速居多(41.7%),其次为永久性交界性往复式心动过速(20.8%)、室性心动过速(16.7%)、房室再入性心动过速或房室结性再入性心动过速(10.4%)。药物治疗是主要的治疗方法,但70.8%的患者需要至少一次消融手术。所有患者在治疗后左心室射血分数均有显著改善,大多数患者在就诊后平均80天内至少达到接近正常的射血分数。总之,TIC总体上是一种可治疗的疾病,诊断具有挑战性,但如果诊断和治疗得当,通常预后良好。本文强调在室性功能降低的情况下,考虑TIC在心动过速鉴别诊断中的重要性,以识别它并使其能够尽快开始有针对性的治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tachycardia-Induced Cardiomyopathy: A Case Series and a Literature Review
Tachycardia-induced cardiomyopathy (TIC), also known as arrhythmia-induced cardiomyopathy or tachycardiomyopathy, is a reversible form of heart failure characterized by persistent tachyarrhythmias and associated ventricular dysfunction. TIC is characterized by the reversal of myocardial damage with resolution of the arrhythmia. Early diagnosis of TIC is imperative, as the treatment course is distinct from cardiomyopathy of other or unknown causes. However, distinguishing TIC from tachycardia secondary to increased catecholamines due to congestive heart failure can be very challenging. There are relatively few paediatric reports, and herein we present a case series of 48 paediatric patients with TIC from literature (2014-2024). We also present 4 illustrative cases with TIC seen at our site (BC Children’s Hospital, Vancouver, Canada). The mean age in this case series was 6.98 ± 4.9 years. The majority of patients had ectopic atrial tachycardia (41.7%), followed by permanent junctional reciprocating tachycardia (20.8%), ventricular tachycardia (16.7%), and atrioventricular re-entrant tachycardia or atrioventricular nodal re-entrant tachycardia (10.4%). Pharmacologic treatment was the predominant therapy, but 70.8% of patients needed at least 1 ablation procedure. All patients demonstrated significant improvement in left ventricular ejection fraction after treatment, with most achieving at least near-normal ejection fractions in 80 days on average since presentation. In conclusion, TIC is overall a treatable condition with challenging diagnosis but generally has a favourable prognosis when diagnosed and treated appropriately. This article emphasizes the importance of considering TIC in the differential diagnosis of tachycardia in the context of reduced ventricular function, to recognize it and to enable targeted treatment initiation as soon as possible.
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