文献简介

出版社:Pediatr Cardiol (2013) 34:383–389

作  者:Sevket Balli • Mehmet Burhan Oflaz

编  号:10.1007/s00246-012-0467-5

关键字:Acute rheumatic fever  Conduction  Rhythm

年  份:2013   点击量:257

文献摘要

  Various rhythm and conduction abnormalities can develop in acute rheumatic fever. This study investigated rhythm and conduction abnormalities in children with acute rheumatic fever using a standard 12-lead electrocardiogram and 24-h rhythm Holter recordings. This multicenter retrospective study, performed between August 2011 and March 2012, enrolled 73 consecutive children with acute rheumatic fever. Standard electrocardiography was used to measure PR and corrected QT intervals. Holter recordings were evaluated for all the patients, and 52 of the patients (71.2 %) had carditis that was either isolated or together with other major criteria. A positive correlation was detected between carditis and the mean PR interval on standard electrocardiography, but this was not significant (p>0.05). Standard electrocardiography showed a significant positive correlation between PR and corrected QT intervals (p = 0.03; r = 0.55). Standard electrocardiography showed only three patients (4.2 %) with premature contractions, whereas 24-h electrocardiography showed 26 patients (35.6 %) with premature contractions. Carditis was positively correlated with premature contractions (p<0.01;r = 0.57). One patient with junctional rhythm and one patient with left bundle block were detected by standard electrocardiography. Whereas some patients with carditis exhibited no arrhythmic evidence on standard electrocardiograms, complete atrioventricular block, supraventricular tachycardia, and Mobitz type 1 block were observed on 24-h Holter recordings. A positive correlation also was observed between the presence of premature contractions and serum levels of acute-phase reactants (p = 0.03; r = 0.62). These findings led to the conclusion that rhythm and conduction disorders in acute rheumatic fever are more common than previously thought.

  急性风湿热中通常会出现不同的节律和传导异常。本研究使用标准12导联心电图和24小时 Holter动态心电图记录仪来探讨儿童急性风湿热的节律和传导异常。这项多中心回顾性研究在 2011年8月至2012年3月之间进行,共纳入73名急性风湿热儿童。标准的心电图被用来衡量PR和校正QT间期。我们利用Holter记录仪对所有患者进行了评估,其中52名患者(71.2%)有心脏炎,这可能是单独诊断的也可能与其他主要标准一起共同诊断的。检测到心脏炎与标准心电图的平均PR间期之间存在正相关关系,但并不显著(p >0.05)。标准心电图显示PR和校正的QT间期之间存在显著的正相关性(p = 0.03和r = 0.55 )。标准心电图显示只有3位患者(4.2%)出现期外收缩,而24小时心电图检查显示26位患者(35.6%)出现期外收缩现象。心脏炎与期外收缩呈明显正相关(p < 0.01和r = 0.57)。采用标准心电图对一名交界性心律患者和一名左束支传导阻滞患者进行了检测。然而有些心脏炎患者在标准心电图上并没有表现出心律失常的迹象,但利用24小时Holter记录仪则可以观察到完全性房室传导阻滞、室上性心动过速和莫氏1型阻滞。同时,我们也观察到期外收缩与急性期反应物的血清水平呈正相关(p = 0.03和r = 0.62)。这些发现得出了这一结论,即急性风湿热中的节律和传导失常比过去认为的更为常见。