Kovacikova Lubica, Hakacova Nina, Dobos Dusan, Skrak Peter, Zahorec Martin
Intensive Care Unit, Children's Cardiac Center, Bratislava, Slovakia.
Ann Thorac Surg. 2009 Aug;88(2):616-22. doi: 10.1016/j.athoracsur.2009.04.088.
Postoperative junctional ectopic tachycardia is a potentially life-threatening arrhythmia that is often resistant to conventional antiarrhythmic drugs. Amiodarone was suggested to be an adequate treatment; however, data regarding its efficacy and safety are limited. This study evaluated the efficacy of amiodarone in the first-line treatment of postoperative junctional ectopic tachycardia and assessed factors associated with failure of amiodarone therapy.
The study included 40 pediatric cardiosurgical patients with postoperative junctional ectopic tachycardia. Intravenous amiodarone in 2-mg/kg boluses and, if necessary, as continuous infusion (10 to 15 mug/kg/min), were used as the first-line therapy. Restoration of sinus rhythm or slowing of junctional ectopic tachycardia to a rate that allowed atrial or atrioventricular sequential pacing was considered as efficacy of therapy.
Amiodarone was effective in 18 patients (45%). Sinus rhythm was achieved in 7, and heart rate decreased in 11 patients from 180 (range, 173 to 200) to 142 (range, 133-155) beats/min (p < 0.0001) and allowed effective pacing with atrioventricular synchrony. Higher arteriovenous oxygen saturation difference (p = 0.007) and lower body temperature (p = 0.02) were associated with failure of amiodarone therapy.
Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia.
术后交界性异位性心动过速是一种潜在的危及生命的心律失常，常对传统抗心律失常药物耐药。胺碘酮被认为是一种有效的治疗药物；然而，关于其疗效和安全性的数据有限。本研究评估了胺碘酮在术后交界性异位性心动过速一线治疗中的疗效，并评估了与胺碘酮治疗失败相关的因素。
该研究纳入了40例术后发生交界性异位性心动过速的儿科心脏手术患者。静脉注射胺碘酮，负荷剂量为2mg/kg，必要时持续输注（10至15μg/kg/min），作为一线治疗。窦性心律恢复或交界性异位性心动过速减慢至允许心房或房室顺序起搏的心率被视为治疗有效。
胺碘酮对18例患者（45%）有效。7例患者恢复窦性心律，11例患者心率从180次/分（范围173至200次/分）降至142次/分（范围133 - 155次/分）（p < 0.0001），并允许进行有效的房室同步起搏。动静脉血氧饱和度差较高（p = 0.007）和体温较低（p = 0.02）与胺碘酮治疗失败相关。
胺碘酮作为一线治疗对几乎一半的术后交界性异位性心动过速患者有效。动静脉血氧饱和度差较高和体温较低与胺碘酮治疗失败相关，它们的存在可能提示更积极的初始治疗方法，即胺碘酮联合低温治疗。
