Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnett Ave, Cincinnati, OH 45229, USA.
Pediatrics. 2012 Sep;130(3):e685-9. doi: 10.1542/peds.2011-1257. Epub 2012 Aug 6.
Pallid breath-holding (PBH) is a childhood condition that presents with recurrent syncope. Although typically benign, severe cases can lead to asystole and anoxic seizures. Previous studies have advocated pacemaker placement to abbreviate symptoms. This was a retrospective study of patients treated with fluoxetine for PBH spells. Clinical response, side effects and avoidance of pacemaker implantation were reviewed in six patients (12-60 months) treated with fluoxetine for PBH. Patients were referred because of concern of arrhythmia and failed medical treatment strategies. Two patients had previously implanted loop recorders, 5 patients had documented episodes of asystole, and 2 patients had generalized seizures. Fluoxetine resulted in alleviation of syncope in 5 of 6 patients. Time to symptomatic improvement symptoms ranged from 2 days to 1 month (median, 2 weeks). Median duration of treatment with fluoxetine was 12 months (12-24 months). One patient demonstrated no improvement and had a pacemaker implanted. There were no reported side effects to fluoxetine. Fluoxetine can be used to treat childhood PBH spells and may obviate the need for permanent pacing in a significant subset of this population. Considering its safe side-effect profile it is a worthwhile first-line agent to treat this disorder.
苍白性屏气发作（PBH）是一种以反复晕厥为特征的儿童疾病。虽然通常是良性的，但严重病例可导致心脏停搏和缺氧性癫痫发作。以前的研究主张使用起搏器来缩短症状持续时间。这是一项对使用氟西汀治疗 PBH 发作的患者进行的回顾性研究。对 6 名（12-60 个月）因心律失常和药物治疗失败而接受氟西汀治疗的 PBH 患者进行了临床反应、副作用和避免植入起搏器的评估。两名患者曾植入过环路记录器，5 名患者有记录到心脏停搏发作，2 名患者有全身性癫痫发作。氟西汀使 6 名患者中的 5 名晕厥得到缓解。症状改善的时间从 2 天到 1 个月不等（中位数为 2 周）。氟西汀治疗的中位时间为 12 个月（12-24 个月）。一名患者没有改善，植入了起搏器。氟西汀没有报告副作用。氟西汀可用于治疗儿童 PBH 发作，并可能避免该人群中相当一部分患者需要永久性起搏。鉴于其安全的副作用谱，它是治疗这种疾病的一种有价值的一线药物。
