Villain E, Bonnet D, Kachaner J, Le Bidois J, Cohen L, Piéchaud J F, Sidi D
Service de cardiologie pédiatrique du hôpital Necker-Enfants Malades, Paris.
Arch Mal Coeur Vaiss. 1990 May;83(5):665-71.
Reduction of the arrhythmia was obtained in 1 to 5 days, spontaneously (2 cases) of after oral amiodarone (500 to 2000 mg/m2/24 hr) (5 cases) or intravenous flecainide or propafenone in the two most critically ill patients. With the exception of 1 patient who was successfully treated with propranolol for 1 year, amiodarone was prescribed in all cases for 7 to 36 months after reversion to sinus rhythm: 5 children have been taken off treatment and seem to be completely cured 4 to 9 years after withdrawal; the other 3 patients have not had recurrences but have only been treated for 6 to 15 months. One of them has neurological sequellae from a cerebral embolism originating from an atrial thrombus. These results show that incessant ventricular tachycardia in infancy is a serious condition but amenable to medical treatment with high dose amiodarone or, when poorly tolerated, intravenous Class 1c antiarrhythmics for reduction of the arrhythmia, and amiodarone at adequate doses for 2 years to prevent recurrence. With the exception of the rare arrhythmogenic right ventricular dysplasia, the long term prognosis would seem to be excellent and, in general, there would seem to be little need for surgery.
1至5天内心律失常得到缓解，其中2例为自发缓解，5例在口服胺碘酮（500至2000mg/m²/24小时）后缓解，另外2例病情最危重的患者在静脉注射氟卡尼或普罗帕酮后缓解。除1例患者用普萘洛尔成功治疗1年外，所有病例在恢复窦性心律后均服用胺碘酮7至36个月：5名儿童已停药，停药后4至9年似乎已完全治愈；其他3例患者未复发，但仅接受了6至15个月的治疗。其中1例因心房血栓导致脑栓塞而有神经后遗症。这些结果表明，婴儿期持续性室性心动过速是一种严重疾病，但可通过高剂量胺碘酮或在耐受性差时静脉注射1c类抗心律失常药物来减少心律失常，并通过适当剂量的胺碘酮治疗2年以预防复发。除罕见的致心律失常性右室发育不良外，长期预后似乎良好，一般而言，似乎很少需要手术治疗。
