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中华脑血管病杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 488 -494. doi: 10.11817/j.issn.1673-9248.2024.05.014

临床病例研究

直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习
陈晓胜1, 何佳2, 刘方2, 吴蕊3, 杨海涛3, 樊晓寒2,()   
  1. 1.450003 郑州,郑州大学附属胸科医院 河南省胸科医院心血管内科
    2.100037 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院功能检测中心
    3.451464 郑州,郑州大学华中阜外医院 阜外华中心血管病医院 河南省人民医院心脏中心 心血管内科
  • 收稿日期:2024-07-30 出版日期:2024-10-01
  • 通信作者: 樊晓寒
  • 基金资助:
    河南省医学科技攻关计划联合共建项目(LHGJ20200089)

Pacemaker implantation in a child with a 31-second cardiac arrest induced by tilt table test: a case report and literature review

Xiaosheng Chen1, Jia He2, Fang Liu2, Rui Wu3, Haitao Yang3, Xiaohan Fan2,()   

  1. 1.Department of Cardiology, Chest Hospital of Zhengzhou University, Henan Provincial Chest Hospital,Zhengzhou 450003, China
    2.Center of Cardiac Function, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Fuwai Hospital, Beijing 100037,China
    3.Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Fuwai Central China Cardiovascular Hospital, Henan Provincial People's Hospital Heart Center, Zhengzhou 451464, China
  • Received:2024-07-30 Published:2024-10-01
  • Corresponding author: Xiaohan Fan
引用本文:

陈晓胜, 何佳, 刘方, 吴蕊, 杨海涛, 樊晓寒. 直立倾斜试验诱发31 秒心脏停搏的植入心脏起搏器儿童一例并文献复习[J]. 中华脑血管病杂志(电子版), 2024, 18(05): 488-494.

Xiaosheng Chen, Jia He, Fang Liu, Rui Wu, Haitao Yang, Xiaohan Fan. Pacemaker implantation in a child with a 31-second cardiac arrest induced by tilt table test: a case report and literature review[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(05): 488-494.

目前,关于儿童血管迷走性晕厥患者接受植入心脏起搏器治疗的研究非常有限。本文报告了1 例7 岁男性儿童,曾反复晕厥,经直立倾斜试验诱发出长达31 s 的心脏停搏。经家属和医师共同讨论决定为该患者植入具有闭环刺激功能的起搏器,并辅以酒石酸美托洛尔治疗,经过随访观察,治疗效果显著,晕厥未再复发,复查倾斜试验可见起搏工作避免血压心率下降的发生。本文还回顾和总结了1990 年至2024 年期间共有23 例儿童因血管迷走性晕厥而接受起搏治疗的相关文献,旨在探讨此类患者的个体化诊断治疗方案。

Currently, studies on the treatment of pediatric vasovagal syncope with pacemaker implantation are very limited. This article reports a case of a 7-year-old male child who experienced recurrent syncope. A tilt table test induced a prolonged cardiac arrest lasting up to 31 seconds. After through consultation with the family a pacemaker with closed loop stimulation function was implanted in the patient, and he was treated with Metoprolol Tartrate. Follow-up assessments showed significant treatment benefits,with no recurrence of syncope, and the tilt table test showing that the pacing function prevented a decrease in blood pressure and heart rate. This article also reviews and summarizes the literature from 1990 to 2024, encompassing 23 pediatric cases of vasovagal syncope treated with pacemakers, aiming to explore personalized diagnostic and treatment approaches for this patient population..

图1 患者在直立倾斜试验中心脏停搏心电图。图a 患者刚开始出现心脏停搏的0~6 s;图b 患者心脏停搏的7~16 s 开始胸外按压;图c 患者心脏停搏17~26 s 持续胸外按压;图d 患者心脏停搏的27~31 s 恢复自主心律
图2 患者接受起搏治疗后复查心电图
图3 患者接受起搏治疗后复查胸片
表1 血管迷走性晕厥儿童起搏治疗研究的病案资料
图4 文献入选流程图
1
Soteriades ES, Evans JC, Larson MG, et al. Incidence and prognosis of syncope [J]. N Engl J Med, 2002, 347(12): 878-885.
2
Brignole M, Moya A, De Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope [J]. Eur Heart J, 2018, 39(21):1883-1948.
3
Wang C, Li Y, Liao Y, et al. 2018 Chinese Pediatric Cardiology Society (CPCS) guideline for diagnosis and treatment of syncope in children and adolescents [J]. Sci Bull (Beijing), 2018, 63(23):1558-1564.
4
Shah MJ, Silka MJ, Silva JNA, et al. 2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients [J]. Heart Rhythm,2021, 18(11): 1888-1924.
5
Brignole M, Russo V, Arabia F, et al. Cardiac pacing in severe recurrent reflex syncope and tilt-induced asystole [J]. Eur Heart J,2021, 42(5): 508-516.
6
Paech C, Wagner F, Mensch S, et al. Cardiac pacing in cardioinhibitory syncope in children [J]. Congenit Heart Dis, 2018, 13(6): 1064-1068.
7
Mcleod KA, Wilson N, Hewitt J, et al. Cardiac pacing for severe childhood neurally mediated syncope with reflex anoxic seizures [J].Heart, 1999, 82(6): 721-725.
8
Bestawros M, Darbar D, Arain A, et al. Ictal asystole and ictal syncope:insights into clinical management [J]. Circ Arrhythm Electrophysiol,2015, 8(1): 159-164.
9
Connolly SJ, Sheldon R, Roberts RS, et al. The North American Vasovagal Pacemaker Study (VPS). A randomized trial of permanent cardiac pacing for the prevention of vasovagal syncope [J]. J Am Coll Cardiol, 1999, 33(1): 16-20.
10
Sutton R, Brignole M, Menozzi C, et al. Dual-chamber pacing in the treatment of neurally mediated tilt-positive cardioinhibitory syncope:pacemaker versus no therapy: a multicenter randomized study. The Vasovagal Syncope International Study (VASIS) Investigators [J].Circulation, 2000, 102(3): 294-299.
11
Connolly SJ, Sheldon R, Thorpe KE, et al. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS Ⅱ): a randomized trial [J]. JAMA, 2003, 289(17): 2224-2229.
12
Occhetta E, Bortnik M, Audoglio R, et al. Closed loop stimulation in prevention of vasovagal syncope. Inotropy Controlled Pacing in Vasovagal Syncope (INVASY): a multicentre randomized, single blind, controlled study [J]. Europace, 2004, 6(6): 538-547.
13
Palmisano P, Zaccaria M, Luzzi G, et al. Closed-loop cardiac pacing vs. conventional dual-chamber pacing with specialized sensing and pacing algorithms for syncope prevention in patients with refractory vasovagal syncope: results of a long-term follow-up [J]. Europace,2012, 14(7): 1038-1043.
14
Baron-Esquivias G, Morillo CA, Moya-Mitjans A, et al. Dual-chamber pacing with closed loop stimulation in recurrent reflex vasovagal syncope: the SPAIN Study [J]. J Am Coll Cardiol, 2017, 70(14): 1720-1728.
15
Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy [J]. Eur Heart J,2021, 42(35): 3427-3520.
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