Liberman Leonardo, Hordof Allan J, Altmann Karen, Pass Robert H
Pediatric Arrhythmia Service, Department of Pediatrics, New York Presbyterian Hospital, Columbia University, New York, New York, USA.
Pacing Clin Electrophysiol. 2006 Dec;29(12):1383-6. doi: 10.1111/j.1540-8159.2006.00551.x.
Low-dose biphasic waveform cardioversion has been used for the termination of atrial arrhythmias in adult patients. The energy required for termination of atrial arrhythmias in pediatric patients is not known. The objective of this study is to determine the minimum energy required for successful external cardioversion of atrial arrhythmias in pediatric patients using biphasic waveform current.
Prospective study of all patients less than 24 years of age with and without congenital heart disease undergoing synchronized cardioversion for atrial arrhythmias. Patients were assigned to receive an initial biphasic energy shock of 0.2-0.5 J/kg and if unsuccessful in terminating the arrhythmia, subsequent sequential shocks of 1 and 2 J/kg would be administered until cardioversion was achieved. The end point of the cardioversion protocol was successful cardioversion or delivery of three shocks.
Between June 2005 and June 2006, 16 patients underwent biphasic cardioversion for atrial flutter or fibrillation. The mean age was 14.7 +/- 6.4 years (range: 2 weeks to 24 years). The mean weight was 51 +/- 21 kg (range: 3.8-82 kg). Seven patients had normal cardiac anatomy, three had a single ventricle (Fontan), two had a Senning operation; the remaining four patients had varied forms of congenital heart disease. The median length of time that the patients were in tachycardia was 12 hours (range: 5 minutes to 2 months). Using either transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE), no thrombi were identified in any patient. All patients were successfully cardioverted with biphasic waveform energy. The successful energy shock was 0.35 +/- 0.19 J/kg (range: 0.2-0.9 J/kg). All but one patient were successfully cardioverted with less than 0.5 J/kg. The transthoracic impedance range was between 41 and 144 Omega; one patient had an impedance of 506 Omega (2-week-old infant with a weight of 3.8 kg). The mean current delivered was 5.4 +/- 2.2 A (range: 1-11 A).
Low-dose energy using biphasic waveform shocks can be used for successful termination of atrial arrhythmias in pediatric patients with and without congenital heart disease.
低剂量双相波电复律已用于终止成年患者的房性心律失常。小儿患者终止房性心律失常所需的能量尚不清楚。本研究的目的是确定使用双相波电流对小儿患者房性心律失常进行成功体外电复律所需的最低能量。
对所有年龄小于24岁、患有或未患有先天性心脏病且因房性心律失常接受同步电复律的患者进行前瞻性研究。患者被分配接受初始0.2 - 0.5 J/kg的双相能量电击，如果未能终止心律失常，则随后依次给予1和2 J/kg的电击，直至实现电复律。电复律方案的终点是成功电复律或给予三次电击。
2005年6月至2006年6月期间，16例患者接受了双相波电复律治疗房扑或房颤。平均年龄为14.7±6.4岁（范围：2周龄至24岁）。平均体重为51±21 kg（范围：3.8 - 82 kg）。7例患者心脏解剖结构正常，3例为单心室（Fontan手术），2例接受了Senning手术；其余4例患者患有各种形式的先天性心脏病。患者心动过速的中位时间为12小时（范围：5分钟至2个月）。使用经胸超声心动图（TTE）或经食管超声心动图（TEE），未在任何患者中发现血栓。所有患者均通过双相波能量成功电复律。成功的能量电击为0.35±0.19 J/kg（范围：0.2 - 0.9 J/kg）。除1例患者外，所有患者均以低于0.5 J/kg的能量成功电复律。经胸阻抗范围在41至144Ω之间；1例患者的阻抗为506Ω（体重3.8 kg的2周龄婴儿）。平均输送电流为5.4±2.2 A（范围：1 - 11 A）。
使用双相波电击的低剂量能量可用于成功终止患有或未患有先天性心脏病的小儿患者的房性心律失常。
