Cawley M J, Al-Jazairi A S, Stone E A
Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, PA 19104-4495, USA.
Ann Pharmacother. 2001 Mar;35(3):303-7. doi: 10.1345/aph.10106.
To report a case of bradycardia secondary to atrioventricular nodal block (AVNB) successfully treated with intravenous theophylline. Intravenous theophylline was used as an alternative to temporary pacing in a patient with sepsis secondary to thermal injury.
A 79-year-old white woman with significant cardiac history was admitted with 14.5% total body surface area burns after a house fire. Cardiac events included intermittent episodes of sinus bradycardia complicated by the development of second-degree AVNB and periods of sinus arrest. Intravenous theophylline initiation maintained normal sinus rhythm without further episodes of sinus bradycardia or heart block, thus preventing the need for cardiac pacemaker placement.
This is the first case published in the English-language literature describing the use of intravenous theophylline as an alternative therapy to temporary pacing in a patient with sepsis secondary to thermal injury. Bradyarrhythmic events in sepsis patients have been associated with catecholamine production increasing adenosine formation. High concentrations of adenosine in the areas of the sinoatrial or atrioventricular nodal regions may induce sinus bradycardia or AVNB. Theophylline, an adenosine antagonist, has been identified as a treatment option for such bradyarrhythmic events.
Theophylline, a methylxanthine derivative, may represent an alternative to other pharmacologic therapies and temporary pacing in the treatment of bradycardia secondary to AVNB. These agents may represent a pharmacologic alternative in patients in whom other pharmacologic strategies or cardiac pacemaker insertion may be contraindicated.
报告一例继发于房室结阻滞（AVNB）的心动过缓患者经静脉注射茶碱成功治疗的病例。在一名因热损伤继发脓毒症的患者中，静脉注射茶碱被用作临时起搏的替代方法。
一名有显著心脏病史的79岁白人女性，在房屋火灾后因全身14.5%体表面积烧伤入院。心脏事件包括间歇性窦性心动过缓发作，并伴有二度AVNB的发展以及窦性停搏期。开始静脉注射茶碱后维持了正常窦性心律，未再出现窦性心动过缓或心脏传导阻滞发作，从而避免了放置心脏起搏器的需要。
这是英文文献中发表的首例描述在因热损伤继发脓毒症的患者中使用静脉注射茶碱作为临时起搏替代疗法的病例。脓毒症患者的缓慢性心律失常事件与儿茶酚胺生成增加导致腺苷形成有关。窦房结或房室结区域高浓度的腺苷可能诱发窦性心动过缓或AVNB。茶碱作为一种腺苷拮抗剂，已被确定为治疗此类缓慢性心律失常事件的一种选择。
茶碱作为一种甲基黄嘌呤衍生物，在治疗继发于AVNB的心动过缓方面可能是其他药物治疗和临时起搏的替代方法。在其他药物策略或心脏起搏器植入可能禁忌的患者中，这些药物可能代表一种药物替代方法。
