Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 35(4): 238-248 (2019)
doi:10.9794/jspccs.35.238

ReviewReview

小児上室頻拍の心電図診断と急性期治療Diagnosis and Acute Therapy of Supraventricular Tachycardia in Children

国立循環器病研究センター小児循環器内科Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center ◇ Osaka, Japan

発行日:2019年11月1日Published: November 1, 2019
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小児の上室頻拍の臨床像は成人とは異なり,年代に合わせた対応が必要である.乳児期には心不全による症状が主となり,発見が遅れて重症化することがある.学童期以降では動悸が主症状となり,軽症なことが多い.小児においては持続する頻拍では頻拍誘発性心筋症を来すことがあり,成人以上に注意が必要である.小児の上室頻拍では房室回帰性頻拍,房室結節回帰性頻拍で90%を占め,異所性心房頻拍などの他の不整脈は稀である.心電図診断においては,P波を認識し,P波の波形,QRS波との時間関係などを確認する.アデノシン三リン酸投与を併用するとより正確な診断が可能となる.急性期治療において,血行動態が安定していない場合はただちに同期下カルディオバージョンを行う.血行動態が安定していれば,迷走神経刺激,アデノシン三リン酸投与を要し,多くのSVTは停止する.停止しないSVTに対しては他の抗不整脈薬投与が必要となる.本稿では,小児SVTの心電図診断の具体的な方法を概説し,急性期治療の新たな知見を紹介する.

The clinical characteristics of supraventricular tachycardia (SVT) in children differ from those in adults. SVT has a nonspecific presentation in neonates and infants with symptoms caused by heart failure and sometimes becomes severe because of delayed diagnosis. In older children, palpitations may be a subjective complaint, and most SVTs have a mild presentation. Tachycardia-induced cardiomyopathy secondary to incessant SVT is more often observed in children than in adults. Atrioventricular reciprocating tachycardia and atrioventricular nodal re-entrant tachycardia account for >90% of cases of pediatric SVT, and ectopic atrial tachycardia and other SVTs are less common. The first step in the electrocardiographic diagnosis of SVT involves detection of the P wave, followed sequentially by assessment of P wave morphology and assessment of the time relationship between P waves and QRS complexes. Intravenous administration of adenosine triphosphate is useful for elucidation of the mechanism of SVTs. In hemodynamically unstable children, acute management includes performing immediate synchronized cardioversion. If the child is stable, performing a vagal maneuver and/or intravenous administration of adenosine triphosphate can achieve termination of most SVTs. Administration of second-line antiarrhythmic agents is necessary to treat intractable SVTs. This review discusses a practical approach to electrocardiographic diagnosis of this condition and provides a brief overview of recent information about acute management of pediatric SVT.

Key words: supraventricular tachycardia; electrocardiographic diagnosis; adenosine triphosphate; antiarrhythmic agent; Valsalva maneuver

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This page was last modified on 2019-12-17T11:59:29.000+09:00


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