独立行政法人地域医療機能推進機構滋賀病院小児科Department of Pediatrics, Japan Community Health care Organization Shiga Hospital ◇ Shiga, Japan
背景：2016年，学校心臓検診のガイドラインが改定され，接合部調律は全例要精査，心室拍数80回/分を超える場合には上室頻拍に準じた管理とされた．しかし，学校心臓検診における接合部調律の頻度，心拍数についての十分なデータはなく，ガイドラインの変更が学校心臓検診の現場に与える影響は不明である．
方法：大津市学校心臓検診対象者の7,108人において，接合部調律の頻度，心拍数について検討した．
結果：接合部調律の頻度は，小学校1年生で55人（2.4％），小学校4年生で73人（3.0％），中学校1年生で76人（3.3％）であった．平均心拍数は，それぞれ79.2±7.9回/分，76.7±8.6回/分，72.5±9.9回/分であった．
結論：学校心臓検診においては，接合部調律は従来想定されているよりも頻度は高い．心拍数もガイドラインで想定されている30～60回/分よりも速く，年齢が小さいほど顕著であった．
Background: The Japanese society of pediatric cardiology and cardiac surgery revised the guidelines for school cardiac screening in 2016. All students with atrioventricular (AV) junctional rhythm must now undergo further examination, and those with a heart rate of ＞80 beats/min must be managed using the same protocol as that used for those with supraventricular tachycardia. However, data are lacking on the frequency of AV junctional rhythm or heart rate in school cardiac screening, and the impact of the guideline change on the findings of school cardiac screening is unclear.
Methods: The frequency of AV junctional rhythm and corresponding heart rate were examined in 7,108 students who underwent cardiac screening at municipal schools in Otsu. AV junctional rhythm was visually determined on the basis of negative P waves in leads II, III, and aVF, rather than using an automated electrocardiogram reading. The PQ interval and whether the P wave was observed before, during, or after the QRS wave were not included in the diagnostic criteria; everything considered to be a negative P wave was extracted.
Results: AV junctional rhythm was detected in 55 first graders (2.4％), 73 fourth graders (3.0％), and 76 seventh graders (3.3％); the heart rate in these groups showed a normal distribution with peaks of 79.2 (SD 7.9), 76.7 (8.6), and 72.5 (9.9) beats/min, respectively.
Conclusions: In school cardiac screening, AV junctional rhythm was found more frequently than previously assumed. The heart rate in these students was also faster than the 30–60 beats/min assumed in the guidelines and was faster at younger ages.
Key words: atrioventricular junctional rhythm; school cardiac screening; guidelines for heart disease screening in schools
© 2020 特定非営利活動法人日本小児循環器学会© 2020 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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This page was last modified on 2020-06-18T10:43:22.000+09:00
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