[Multicenter investigation of the correlation between supraventricular tachycardia and tachycardia-induced cardiomyopathy in children].

Objective: This study aimed to investigate the correlation between supraventricular tachycardia (SVT) and tachycardia-induced cardiomyopathy(TIC) in children and assess the risk factors for the development of TIC. Method: One hundred and eighty-three patients were recruited in four hospitals of Beijing diagnosed as SVT were divided into two groups depending on whether or not complicated with TIC. The age, gender, tachycardia type, ventricular rate during tachycardia, frequency of tachycardia episodes and duration of tachycardia were compared between the two groups and risk factors associated with TIC were analyzed. Statistical analyses were performed using t test, Mann-Whitney U and χ(2) test. Result: Totally 183 patients were included in this study (paroxysmal supraventricular tachycardia, PSVT, n=149; atrial tachycardia, AT, n=34). The incidence of TIC was 13.1%. There was significant difference regarding the incidence of TIC between children with AT and children with PSVT (26.5% vs. 10.1%, χ(2)=6.537, P=0.011). The percentage of AT in patients with TIC was significantly higher than patients without TIC (37.5% vs. 15.7%, χ(2)=6.537, P=0.011). Patients with TIC had a higher frequency of tachycardia episodes(2.5(1.0-4.8) beats/year vs 4.0(1.0-10.0) beats/year, Z=-2.223, P=0.026)and longer duration of tachycardia(11.0(1.1-36.0) h vs 2.5(1.0-12.0) h, Z=-2.154, P=0.031)compared with patients without TIC. Multivariate predictors of TIC was longer duration of tachycardia (OR=2.041, P=0.028). Conclusion: TIC occurs in 13.1% of children with SVT. The incidence of TIC in children with AT is higher than in children with PSVT. Risk factor for the development of TIC is longer duration of tachycardia.目的： 探讨儿童室上性心动过速(室上速)与心动过速性心肌病相关性及致心动过速性心肌病的高危因素。 方法： 以2015年1月至2016年10月在北京4家医院就诊室上速患儿为研究对象，多中心前瞻性观察研究，根据左室射血分数改变分为心肌病及非心肌病组，分析年龄、性别、室上速发作类型、心室速率、发作频率及发作持续时间与心功能损伤的相关性。组间比较计量资料采用独立样本t检验或Mann－Whitney U检验，计数资料采用χ(2)检验。 结果： 183例室上速患儿中，阵发性室上速149例，房性心动过速(房速)34例。心动过速性心肌病发生率为13.1%(24/183)。阵发性室上速及房速致心动过速性心肌病的发生率分别为10.1%(15/149)及26.5%(9/34)，差异有统计学意义(χ(2)＝6.537，P＝0.011)。心肌病组与非心肌病组相比，房速所占比例(37.5%比15.7%，χ(2)＝6.537，P＝0.011)、心动过速发作频率[2.5(1.0～4.8)比4.0(1.0～10.0)次/年，Z＝－2.223，P＝0.026]，心动过速发作持续时间[11.0(1.1～36.0)比2.5(1.0～12.0)h，Z＝－2.154，P＝0.031]组间比较差异有统计学意义。而就诊年龄、首次发病年龄、性别、是否合并感染、是否先天性心脏病、发作时心室率比较差异无统计学意义(Z＝－1.117，P＝0.264；t＝－0.268，P＝0.789；χ(2)＝0.025，P＝0.875；χ(2)＝0.015，P＝0.902；χ(2)＝2.283，P＝0.131；t＝－0.614，P＝0.544)。经二元Logistic回归分析显示，心动过速发作持续时间对心动过速性心肌病的发生差异仍有统计学意义(χ(2)＝4.827，P＝0.028)，而心动过速发作类型及发作频率差异无统计学意义(χ(2)＝2.558，P＝0.110；χ(2)＝0.887，P＝0.346)。通过ROC曲线分析显示预测心动过速性心肌病发生的心动过速发作持续时间最佳临界值为8.5 h(敏感度62.5%，特异度70.4%)。 结论： 4家医院儿童室上速致心动过速性心肌病的发生率为13.1%，其中儿童房速致心动过速性心肌病的发生率显著高于阵发性室上速。发作持续时间是儿童室上速导致心动过速性心肌病的关键高危因素。.