University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Department of Surgery, Little Rock, Ark 72202, USA.
J Thorac Cardiovasc Surg. 2012 Jan;143(1):152-6. doi: 10.1016/j.jtcvs.2011.09.042. Epub 2011 Oct 27.
Junctional ectopic tachycardia is common after pediatric heart surgery. After tetralogy of Fallot repair, the incidence of junctional ectopic tachycardia may be as high as 15% to 20%. We introduced prophylactic amiodarone for tetralogy repair. This study was conducted to evaluate the effectiveness of the prophylactic amiodarone.
A continuous infusion of amiodarone was started in the operating room at the time of rewarming during cardiopulmonary bypass at a rate of 2 mg/kg/d and continued for 48 hours. Between November 2005 and November 2009, 63 consecutive patients underwent primary repair of tetralogy, of whom 20 had prophylactic amiodarone (amiodarone group) and 43 did not (control group). Variables studied included demographic and bypass data, surgical procedure details (transannular or nontransannular patch), preoperative and postoperative echocardiography findings, and postoperative inotropic support. Univariate and stepwise multivariate analyses were conducted to determine factors associated with the occurrence of junctional ectopic tachycardia.
The incidence of junctional ectopic tachycardia was 37% in the control group and 10% in the amiodarone group. The groups were similar in age, weight, bypass time, rate of transannular patch usage, and preoperative and postoperative gradient through the right ventricular outflow tract. Prophylactic amiodarone was significantly negatively associated with junctional ectopic tachycardia by both univariate (P = .039) and multivariate (P = .027) analyses. There were no adverse events attributable to prophylactic amiodarone use.
Prophylactic amiodarone is well tolerated and significantly associated with a decreased incidence of junctional ectopic tachycardia after tetralogy repair.
小儿心脏手术后常发生交界性心动过速。法洛四联症修复术后，交界性心动过速的发生率可能高达 15%至 20%。我们在法洛四联症修复术中引入预防性胺碘酮。本研究旨在评估预防性胺碘酮的疗效。
在体外循环复温时，在手术室开始以 2mg/kg/d 的速度持续输注胺碘酮，持续 48 小时。2005 年 11 月至 2009 年 11 月，连续 63 例患者接受法洛四联症初次修复，其中 20 例接受预防性胺碘酮（胺碘酮组），43 例未接受（对照组）。研究变量包括人口统计学和旁路数据、手术细节（跨瓣环或非跨瓣环补片）、术前和术后超声心动图结果以及术后正性肌力支持。进行单变量和逐步多变量分析，以确定与交界性心动过速发生相关的因素。
对照组交界性心动过速发生率为 37%，胺碘酮组为 10%。两组在年龄、体重、旁路时间、跨瓣环补片使用率以及右心室流出道术后梯度方面相似。胺碘酮的预防性使用与交界性心动过速显著相关，无论是单变量（P=.039）还是多变量（P=.027）分析。预防性胺碘酮的使用没有发生任何不良事件。
预防性胺碘酮耐受性良好，与法洛四联症修复术后交界性心动过速发生率降低显著相关。
