INCESSANT VENTRICULAR-TACHYCARDIA IN INFANTS - MYOCARDIAL HAMARTOMAS AND SURGICAL CURE

[摘要] Infants with incessant ventricular tachycardia (occuring > 10% of the day) have generally been described in pathologic studies. This report describes 21 patients with incessant ventricular tachycardia present > 90% of the day and night; the age at diagnosis ranged from birth to 30 months (mean 10.5 months). The most common clinical presentation was cardiac arrest (11 patients, in 5 after digitalis for presumed supraventricular tachycardia); another 6 patients had congestive heart failure and 4 were asymptomatic. Three patients had coexisting Wolff-Parkinson-White syndrome. The rate of incessant ventricular tachycardia ranged from 167 to 440 (mean 260 beats/min) and the QRS duration from 0.06 to 0.11 second. The most common electrocardiographic (ECG) pattern (10 of 21) was right bundle branch block with left axis deviation, but other right and left bundle branch block patterns were observed. Conventional and investigational antiarrhythmic agents (nine patients received amiodarone) failed to eliminate incessant ventricular tachycardia in all. Electrophysiologic studies localized incessant ventricular tachycardia to the left ventricle in 17 (to the apex in 2, the free wall in 9 and the septum in 6) and to the righ ventricular septum in 4. No structural abnormalities were found on the echocardiogram or angiocardiogram. All patients had surgery at an age of 3.5 to 31 months (mean 16). In 15 a tumor was found: 13 myocardial hamartomas (9 discrete, 4 diffuse througthout both ventricles) and 2 rhabdomyomas (1 multiple). Myocarditis was found in one patient (the oldest). In four, only myocardial fibrosis was found; results of one biopsy were normal. All patients left the operating room with sinus rhythm. There were two early deaths (one due to brain death resulting from a cardiac arrest before operation and one due to low cardiac output in the immediate postoperative period) and one late death from congestive heart failure. The other 18 patients are asymptomatic with sinus rhythm after a follow-up of 9 months to 7 years; only 1 patient is receiving medication for suppression of ventricular arrhythmias; the other 17 are receiving no medication. In conclusion: in infants, incessant ventricular tachycardia is an entity distinct from paroxysmal ventricular tachycardia; it is most often associated with a tumor despite a normal echocardiogram and angiocardiogram. Because medical management usually fails, surgery is recommended early in the course of incessant ventricular tachycardia in infants < 24 months old.

[发布日期] 1987-09-01