142 cases of arrhythmia in the clinical diagnosis and treatment of sick children

     【Abstract】 Objective To observe the clinical features of pediatric arrhythmia explore the clinical indication and timing of medication choice. Methods A retrospective analysis of 142 cases of arrhythmia in children with clinical manifestations and drug characteristics. The results of 142 cases of arrhythmia in children after treatment, 113 patients with heart rhythm to normal, of which 46 were not taking anti-

    arrhythmic drugs; 29 cases associated with the basis for the cause, a high degree of complexity and duration of arrhythmia causes to normal after treatment is not rhythm. Conclusion The clinical indications for drug selection and timing is essential to the treatment of arrhythmia.

     Key words arrhythmia antiarrhythmic drug non-pharmacological treatment

     Arrhythmia is a common disease in children, premature beat, rapid arrhythmia is more common. In recent years, the incidence of arrhythmia in children and found that rate, increasing attendance rates, has become one of the pediatric clinical common diseases. Improve the understanding of arrhythmia in children and to give timely diagnosis and proper treatment of paramount importance. Are now working on 142 cases of children with

    clinical indication and timing of medication choices retrospective analysis, the report is as follows.

     A clinical data

     1.1 General Information

     From January 2007 to January 2008, at the undergraduate treatment of

    children with 142 cases of arrhythmia, 79 patients were male and female 63 cases; newly diagnosed aged 6 months to 12.3 years of age; course 9d ~ 3 years. First examination were treated with myocardial enzymes, cardiac troponin treatment, and chest X-ray, echocardiography, ECG, diagnostic for

a variety of arrhythmias.

     1.2 Treatment

     The main cause for treatment, including the active treatment of the primary disease, infection control, timely and effective oxygen therapy to correct heart failure, cardiac nutrition, protection treatment, and to maintain a stable internal environment and acid-base balance, improve

    circulation treatment. On this basis, some children with the use of anti-

    arrhythmia drugs. According to the following conditions to consider the

    need for the use of anti-arrhythmic drugs: (1) children with the clinical tolerance of arrhythmia; (2) whether there is basis for heart disease; (3) ECG indicators of grade ? or more premature ventricular contractions, ventricular premature associated with other types of premature beats, conduction block, Q-T interval abnormalities, ST-T changes, after the

    premature beat increased exercise test, Q-T interval prolongation, ST-T

    changes significantly, there is more than borne premature beat. With clinical manifestations of the above two, and to consider giving two or more antiarrhythmic drugs. Depending on the origin of arrhythmia in the

    selection of a different anti-arrhythmic drugs, as follows: acting on the sino-atrial node site, use β-blockers, verapamil, diltiazem, digitalis; role of the atrial location, selection of IA, propafenone, amiodarone; act

    on the atrioventricular node area, choose digitalis, β 1 blockers,

    verapamil, diltiazem; acting on the bypass position, choose propafenone, Somalia, he Luo abuse, amine iodide ketone; acting on the ventricular site, choose procaine, quinidine, disopyramide or lidocaine, mexiletine,

    tocainide, or IC propafenone, or amiodarone and Sotalol Luo children.

     2 Results

     142 cases in 113 cases of children with heart rhythm to normal after treatment, of which 46 were in the cure of the original rhythm returned to

    normal after onset, 29 cases of anti-arrhythmic drug has not been applied

    to a normal rhythm, and children with basic causes, the complexity and duration of the arrhythmia. Is not accompanied by cardiac arrhythmia organic disease onset light, easy recovery; course of two years of slow recovery, most of the 3 ~ 5 years to recover part of the illness rarely repeated or increased. Reposted elsewhere in the paper for free download http://

     3 Discussion

     Pediatric Arrhythmia is a common diagnosis and treatment of right or not right after the more important influence in children, serious cardiac arrhythmia if not timely and correct treatment can cause serious consequences. The incidence of arrhythmia in children with the highest

    rate of premature beats, of which ventricular most, followed by atrial, nodal rare. Supraventricular tachycardia caused by a pre-excitation

    syndrome accounted for the first, followed by atrioventricular nodal reentrant tachycardia.

     For a variety of arrhythmias, diagnosis and treatment should follow the following basic procedures: (1) asked in detail about history, especially the past medical history and medication history of arrhythmias; (2) Check the vital signs, especially blood pressure, cardiac function

    assessment model for the rapid heart rate disorders is particularly important; (3) Conventional ECG; (4) if not a state of emergency, line 24h Holter monitoring, cardiac ultrasound, cardiac X-ray examination, as well

    as check blood troponin ?, troponin T, CK with an MB industrial enzymes, anti-myocardial antibodies, ESR, ASO, electrolyte, so as to clear organic cause, or except for heart disease; (5) a comprehensive assessment of arrhythmias in children and its potential implications on the prognosis;

    (6) The decision of the treatment program, including whether the require urgent treatment or further observation [1].

     In recent years, generally agreed that a general contraction without prior use of anti-arrhythmic drug, since the use of anti-arrhythmic drugs

    despite premature contraction can decrease or disappear temporarily, but after stopping re-emergence of long-term effects and non-medication had no

    significant difference [2], or even a long period of cortical hormone

    adrenaline and a variety of anti-arrhythmic drug therapy, the harm far

    more serious prior contraction itself, [3]. Acute treatment should be to terminate the arrhythmia the primary task, long-term treatment should be

    for the purpose of preventing arrhythmias.

     Severe persistent arrhythmia, poor drug therapy should be considered non-drug treatment. Non-pharmacological treatment of arrhythmia, including [4]: (1) radiofrequency catheter ablation (RFCA) treatment of tachyarrhythmia; (2) permanent cardiac pacemaker implantable arrhythmia treatment; (3) In addition to implantable cardiac defibrillation defibrillator (ICD) treatment of malignant arrhythmia, prevention of

sudden cardiac death.

     【References】

     1 TAN Xin, Zhong-Yan Jiang. Arrhythmia status and progress of drug therapy. Practical Clinical Journal of Pediatrics, 2007,22 (1): 6 ~ 8.

     2 Beijing Pediatric myocarditis Collaborative Group. Myocarditis, premature contraction followed up long term. China Pediatrics, 1999,24

    (4): 222.

     3 Torres V. The arrhythmogenicity of antiarrhythmic agents.Am Heart J, 2001,236 (11): 856.

     4 Xiaomei. Arrhythmia status and progress of non-pharmacological

    treatment. Practical Clinical Journal of Pediatrics, 2007,22 (1): 8 ~ 11.

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