Shannon KM
Pediatric Cardiology Research Unit, UCLA School of Medicine, Division of Cardiology, University of California at Los Angeles, 10833 Le Conte Ave., Room B2-427, Los Angeles, CA 90095-1743, USA.
Curr Treat Options Cardiovasc Med. 1999 Dec;1(4):373-379. doi: 10.1007/s11936-999-0033-5.
Improvements in surgical and medical treatment have led to improved survival of infants with congenital heart disease. Coincident with this improved survival has been an increase in the number of patients with congenital heart disease and arrhythmia. Arrhythmias in this population can be life threatening but are more commonly life altering, creating considerable patient distress--both from the symptoms of the arrhythmia and from fear of paroxysmal events. Arrhythmia in the setting of congenital heart disease can result from hemodynamic compromise and can in turn result in more hemodynamic compromise, creating a cycle of clinical deterioration. Aggressive treatment of arrhythmia and aggressive evaluation for surgically correctable hemodynamic burdens is therefore warranted. Treatment options for arrhythmia in patients with congenital heart disease include pharmacologic therapy, catheter intervention, implantable device therapy, and surgical intervention. Pharmacologic therapy is currently the primary mode of treatment of arrhythmia in this setting; however, data from large trials of patients with ischemic or dilated cardiomyopathy suggest that many antiarrhythmic agents may increase overall mortality rates in certain patient groups. In addition, pharmacologic therapy is associated with significant short- and long-term side effects, relatively low success rates, and problems with compliance. For these reasons and because of recent advances in catheter and device therapy, nonpharmacologic therapy should be considered in lieu of medication, whenever possible.
手术和药物治疗的改进提高了先天性心脏病患儿的生存率。伴随着生存率的提高，先天性心脏病合并心律失常的患者数量也有所增加。该人群中的心律失常可能危及生命，但更常见的是改变生活，给患者带来极大痛苦——既有心律失常的症状带来的痛苦，也有对阵发性事件的恐惧带来的痛苦。先天性心脏病背景下的心律失常可由血流动力学障碍引起，反过来又可导致更多的血流动力学障碍，从而形成临床恶化的循环。因此，有必要积极治疗心律失常，并积极评估是否存在可通过手术纠正的血流动力学负担。先天性心脏病患者心律失常的治疗选择包括药物治疗、导管介入、植入式器械治疗和手术干预。药物治疗目前是该情况下心律失常的主要治疗方式；然而，来自缺血性或扩张型心肌病患者大型试验的数据表明，许多抗心律失常药物可能会增加某些患者群体的总体死亡率。此外，药物治疗还伴有显著的短期和长期副作用、相对较低的成功率以及依从性问题。由于这些原因，并且鉴于导管和器械治疗的最新进展，应尽可能考虑采用非药物治疗而非药物治疗。
