[SCD-FORUM] 17S RE: 一例长QT综合征患儿―― Dr. Arabia

[SCD Symposium]

亲爱的Haghjoo教授，
我们同意你所说的，正如你指出的那样，你的这个患 
者有猝死的高度危险。

这个5岁患儿（即使我们忽略她的体重）在接受30mg普 
萘洛尔的治疗之后仍然出现晕厥，且用β阻滞剂后心 
率只有55次/分的事实至少说明她对于这种药物反应不 
好。

在这种情况下，我们宁愿植入ICD，这是一位知名的儿 
童电生理学家提出的意见。植入过程中，我们会尽量 
用心内膜电极/线圈，而不是围绕在左室心外膜和右 
室下壁的心外膜植入。ICD甚至要双腔，心房外膜电极 
可以放置在右心房，可通过提高心率来缩短QT，但要 
保证其内在的传导。

积极干预是基于下一次发作可能就是最后一次发作的 
事实。

感谢这个论坛的组织者以及他们出色的工作。

致
Luis Arabia MD.
Córdoba
Argentina
徐怡琼译  王玲洁校
17S RE A children with LQTS. Dr. Arabia

Dear Dr. Haghjoo,
We agree with you in that your patient is in increased risk of sudden
death by the factors you point out.
The fact that she repeated a syncope event in spite of 30 mg of
propranolol in a 5-year-old child (although we ignore her weight),
with a heart rate of 55 with clear signs of beta block, suggests at
least unsatisfactory response to such medication.
In such a case, we would rather implant an ICD, knowing as a
pediatric electrophysiologist, what this decision implies. We would
attempt the implantation using an endocardial electrode/coil, but
implanted epicardially, surrounding the LV epicardium and the
inferior side of the RV. The ICD may even be a dual-chamber one, and
an atrial epicardial electrode may be implanted in the RA, attempting
to shorten the QT with increase of HR, but allowing intrinsic
conduction.
The aggressiveness in the management is due to the fact that the next
event may be the last in this disease.
Congratulations to the organizers of this symposium for their
excellent work.

Sincerely,
Luis Arabia MD.
Córdoba
Argentina

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee