Pediatric spontaneous atrial tachycardia

Introduction to self-discipline atrial tachycardia in children Automated atrial tachycardia (AAT) is also known as ectopicatrialtachycardia (EAT). Its clinical features are continuous episodes of tachycardia, which lasts for several months to several years, so it is also called chronic atrial tachycardia. Infants and young children often cause tachycardia and heart failure. basic knowledge The proportion of illness: 0.005% Susceptible people: children Mode of infection: non-infectious Complications: acute pulmonary edema, cardiogenic shock

Pediatric autonomic atrial tachycardia

(1) Causes of the disease

More common in children with normal heart structure, a small number of patients with heart disease, due to atrial ectopic lesions 4 phase diastolic depolarization rate increased, ectopic lesions may be in the left or right atrium, may be due to atrial muscle residue self-discipline Caused by embryonic cells.

(two) pathogenesis

Children are more common in chronic autonomic atrial or recurrent episodes of persistent or endless type. These children usually have no obvious organic heart disease. Long-term recurrent tachycardia can lead to tachycardia cardiomyopathy. Found in myocardial ischemia, digitalis poisoning, metabolic disorders, drinking, hypoxia, the mechanism is due to the spontaneous 4-phase diastolic depolarization rate of ectopic atrial foci, intravenous infusion of isoproterenol, can induce self-discipline At the speed of the room, there is a warming phenomenon (the frequency gradually increases). Before the termination, the autonomic heart rate has a slowdown, and the self-regulated atrial speed has an overspeed inhibition phenomenon, which stimulates the vagus nerve, adenosine or calcium antagonist. , the frequency of atrioventricular block does not affect the tachycardia.

Pediatric autonomic atrial tachycardia prevention

Active prevention of congenital heart disease; prevention and treatment of electrolyte imbalance and acid-base imbalance, active treatment of primary disease, such as various gastrointestinal disorders, uremia, rheumatic fever, Kawasaki disease, nervous system factors, hypothermia, anesthesia and drug poisoning caused by arrhythmia . Keep your mood happy and prevent excessive excitement and anxiety. If you have cardiopulmonary disease or other systemic diseases, you should actively treat them. For recurrent episodes and obvious symptoms that affect daily life and work, you should seek medical advice promptly and identify the cause as soon as possible to facilitate prevention and treatment.

Pediatric autonomic atrial tachycardia complications Complications acute pulmonary edema cardiogenic shock

If the patient's heart rate increases for a long time, the heart contraction function may decrease, and dilated cardiomyopathy and congestive heart failure may occur. Symptoms such as vomiting and abdominal pain can significantly increase the formation of dilated cardiomyopathy. Then developed into heart failure. Repeated episodes can be complicated by complications such as arrhythmogenic cardiomyopathy and chronic congestive heart failure. The disease is often caused by other diseases, so its complications are related to the cause. Common complications include acute pulmonary edema, heart failure, and cardiogenic shock.

Pediatric autonomic atrial tachycardia symptoms common symptoms tachycardia palpitations congestive arrhythmia heart enlargement heart failure

Automated atrial tachycardia (AAT), also known as ectopic atrial tachycardia (EAT), is characterized by a sustained onset of tachycardia, ranging from months to years. For a long time, it is also called chronic atrial tachycardia. Infants and young children often lead to the onset of heart a in the preschool age. 31 cases of atopic atrial tachycardia hospitalized in our hospital, 19 cases within 6 years old (61 %), 8 cases (26%) within 1 year old, patients may have irritability, shortness of breath, sweating, palpitations and other symptoms, heart rate 150 times / min or more, but not constant, affected by autonomic nerves, slow down when going to sleep or quiet , wake up or accelerate when the activity, the difference can be more than 50 / min, tachycardia sustained attacks, up to several months to several years, endless tachycardia leading to tachya cardia myopathy (tachycardia cardiomyopathy), left ventricle End-diastolic diameter increased, ejection fraction and short-axis shortening rate decreased, about 50% of children with congestive heart failure, more obvious in infancy, after conversion to sinus rhythm, heart function and heart enlargement returned to normal, no device Children with quality heart disease last for several years, Self-relieving, the prognosis is better.

Pediatric autonomic atrial tachycardia examination

Hypoxemia, acidosis, etc. can be found.

1. ECG characteristics

(1) Atrial tachycardia: The episode lasts for more than 1 month, and the tachycardia is divided into two types:

1 continuous type: continuous attack, no sinus beats in between.

2 repeated type: short-term atrial tachycardia repeated attacks, there are 1 or 2, 3 sinus beats between the attacks, the two types can change each other.

(2) ectopic P wave: clear and easy to see, P wave electric axis mostly 0 ° ~ 90 °, ectopic stove is located in the high right atrium, I, II, aVF lead P wave erect; a few in the left atrium, P wave I Lead inversion, II, III, aVF lead upright; only 3% in the lower right atrium, I, II, III, aVF lead P wave inversion.

(3) Atrial rate: increase, but not constant, most of them are 115~250 times/min, sitting, nervous, irritating, and lying down, quiet, slowing down when going to sleep, the difference between day and night can be more than 50 times / min .

(4) QRS wave: normal shape.

(5) P-QRS relationship: There may be one degree and/or second degree atrioventricular block, which is more common in the former.

2. X-ray film

It can be seen that the heart shadow is enlarged and the pulmonary congestion is manifested.

3.B Ultra

In the absence of bloody heart failure, liver enlargement can be seen.

Diagnosis and diagnosis of pediatric autonomic atrial tachycardia

diagnosis

In addition to the diagnostic criteria for atrial tachycardia, the diagnostic criteria for self-regulating atrial tachycardia have the following points:

1. The procedure stimulates the atria to not induce or terminate the atrial tachycardia, but can be induced spontaneously or by intravenous infusion of isoproterenol.

2. There is a warming up phenomenon when the speed of the room is gradually increased.

3. Can be inhibited by overspeed pacing, hyperkinetic cardiomyopathy, heart failure occurs.

Differential diagnosis

Should be identified with the following supraventricular tachycardia:

1. Paroxysmal supraventricular tachycardia: characterized by sudden onset, more common in children with pre-excitation syndrome.

2. Autonomic borderline tachycardia: mostly persistent episodes, ECG is atrioventricular septum.

3. Persistent borderline repetitive tachycardia (PJRT): special atrioventricular reentry tachycardia, retrograde branch is a recessive bypass with diminished conduction (mostly bypass in the posterior septal area), with a persistent onset However, the electrocardiogram RP/PR>1, the PR interval is normal or shortened, and the P wave II, III, aVF is inverted.

4. Atrial tachycardia with second degree atrioventricular block: an acute attack, common in patients with digitalis poisoning.

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