Clinical Analysis,Follow-up And Literature Review Of Preexcitation Cardiomyopathy In Children

Objective: To increase the understanding of preexcitation cardiomyopathy and improve the level of diagnosis and treatment by analyzing the clinical features,treatment and follow-up of 3 children with preexcitation cardiomyopathy.Methods: 3 children with preexcitation cardiomyopathy diagnosed in the Department of Pediatrics of the second Hospital of Hebei Medical University from 2017 to 2019 were retrospectively analyzed.The medical history,clinical manifestations,auxiliary examination,treatment and prognosis were collected.At the same time,a control trial was conducted with simple asymptomatic WPW syndrome,and the literature was reviewed to understand the influencing factors and prognostic factors of preexcitation cardiomyopathy.Results: The electrocardiogram of all 3 children showed preexcitation syndrome(Wolff-Parkinson-White(WPW)syndrome),had no tachyarrhythmia and other attacks,and the clinical manifestations were heart failure in different degrees.Echocardiography showed that the left ventricular diastolic diameter(Left ventricular end-diastolic diameter,LVDd)was enlarged and the left ventricular function(Ejection fraction EF)decreased in varying degrees.Case 2 showed that the contraction of interventricular septum and left ventricular posterior wall was not synchronized.Except for ventricular enlargement and cardiac insufficiency caused by other causes,all of them were diagnosed as preexcitation cardiomyopathy.After ntracardiac electrophysiological examination,it was found that there were accessory pathways and radiofrequency catheter ablation(Radiofrequency-ablation,RFCA).The preexcitation syndrome disappeared in case 1 and case 2,but there was still preexcitation syndrome in case 3.Echocardiography showed that the left ventricle gradually retracted and the left ventricular function was gradually improved.The prognosis of the disease is good.The type of preexcitation(Number of accessory pathways),the load of preexcitation(Persistent or intermittent)and age at the time of diagnosis may be the influencing factors and prognostic factors of the disease.The duration of QRS wave may be one of the high risk factors.Conclusion: In the absence of persistent or recurrent tachyarrhythmias,preexcitation syndrome may have significant left ventricular dysfunction,and its electrophysiological feature is the existence of accessory pathways.Premature activation of accessory pathways can lead to abnormal interventricular septal motion and ventricular systolic asynchrony,which will aggravate accumulation with time delay,and then lead to ventricular remodeling,cardiac enlargement and cardiac insufficiency.Radiofrequency catheter ablation is the first choice for the treatment of the disease.For infants,amiodarone,flucanil and other drugs can inhibit accessory pathway conduction,improve cardiac function,and have a good prognosis.Combined with this study and literature reports: age at diagnosis,type of preexcitation(Location and number of accessory pathways),preexcitation load(Persistent or intermittent)are pathogenic factors and prognostic factors of preexcitation cardiomyopathy.The duration of QRS wave may be a high risk factor causing disease or affecting prognosis.