Cabrera Duro A, Rodrigo Carbonero D, Galdeano Miranda J M, Martínez Corrales P, Pastor Menchaca E, Macua Biurrun P, Pilar Orive J
Servicio de Cardiología y Cirugía Cardíaca Pediátrica, Hospital Infantil de Cruces, Baracaldo, Bilbao, Spain.
An Esp Pediatr. 2002 Jun;56(6):505-9.
To evaluate treatment of junctional ectopic tachycardia after cardiac surgery.
Twenty-seven patients (5.5 % of 488 patients who underwent surgery) were treated for junctional ectopic tachycardia between 1994 and 1998. There were 14 boys and 13 girls with a mean age of 11 11 months. Seven suffered from tetralogy of Fallot, seven from ventricular septal defect, six from atrioventricular septal defect, three from transposition of the great vessels and the remaining four had other complex heart diseases. The mean initial frequency was 186 27 beats/min. Crystalloid cardioplegia was applied in 274 patients (1994-1996) and 20 patients (7.4 %) showed junctional ectopic tachycardia. Hematic cardioplegia was performed in 214 patients (1997-1998) and seven patients (3.2 %) developed junctional ectopic tachycardia. Of the 33 patients who were treated during the surgical procedure with high mean doses of sympathomimetic catecholamine agents, 27 (81 %) developed tachycardia. Tachycardia developed 8.24 7 hours after surgery (range: 1-24 hours) in 25 patients and after 4 and 5 days in the remaining two patients. The mean duration of tachycardia was 4 days.
In all patients rectal temperature was reduced to 32-34 C. Nineteen patients (70 %) showed a quick response (1-2 hours), although the technique was effective as an isolated procedure in only one patient. Sympathomimetic catecholamine level was reduced to 2-5 g/kg/min in 20 patients but this was effective in 14 (70 %). In 15 patients intravenous amiodarone was also administered and was effective in 11 patients (73 %). Finally, intravenous propafenone was administered to 5 patients. The most effective treatments were hypothermia with reduction of sympathomimetic catecholamine levels in 7 patients (100 %) or intravenous amiodarone in 4 (80 %). Tachycardia led to low cardiac output in 10 patients and only four recovered normal sinus rhythm. Eight patients died. Of these, hemorrhage in the junction area was confirmed in six patients.
Junctional ectopic tachycardia is favored by high levels of sympathomimetic catecholamines after surgery. On the other hand, myocardial protection with hematic cardioplegia reduces tachycardia. Moderate hypothermia with reduction of sympathomimetic agents or intravenous amiodarone reverses ectopic tachycardia.
评估心脏手术后交界性异位性心动过速的治疗效果。
1994年至1998年间，27例患者（占488例接受手术患者的5.5%）接受了交界性异位性心动过速的治疗。其中14例为男孩，13例为女孩，平均年龄为11个月。7例患有法洛四联症，7例患有室间隔缺损，6例患有房室间隔缺损，3例患有大动脉转位，其余4例患有其他复杂心脏病。初始平均心率为186±27次/分钟。274例患者（1994 - 1996年）使用晶体心脏停搏液，20例（7.4%）出现交界性异位性心动过速。214例患者（1997 - 1998年）使用血液心脏停搏液，7例（3.2%）出现交界性异位性心动过速。在手术过程中接受高平均剂量拟交感神经儿茶酚胺药物治疗的33例患者中，27例（81%）出现心动过速。25例患者在术后8.24±7小时（范围：1 - 24小时）出现心动过速，其余2例在术后4天和5天出现。心动过速的平均持续时间为4天。
所有患者直肠温度降至32 - 34摄氏度。19例患者（70%）显示出快速反应（1 - 2小时），尽管该技术仅在1例患者中作为单一治疗方法有效。20例患者的拟交感神经儿茶酚胺水平降至2 - 5μg/kg/分钟，但其中14例（70%）有效。15例患者还接受了静脉注射胺碘酮治疗，11例（73%）有效。最后，5例患者接受了静脉注射普罗帕酮治疗。最有效的治疗方法是7例患者（100%）采用低温并降低拟交感神经儿茶酚胺水平，或4例患者（80%）采用静脉注射胺碘酮。心动过速导致10例患者心输出量降低，只有4例恢复正常窦性心律。8例患者死亡。其中，6例患者被证实交界区出血。
手术后高水平的拟交感神经儿茶酚胺易引发交界性异位性心动过速。另一方面，血液心脏停搏液进行心肌保护可减少心动过速。适度低温并降低拟交感神经药物水平或静脉注射胺碘酮可逆转异位性心动过速。
