Escudero Carolina, Carr Roxane, Sanatani Shubhayan
Division of Cardiology, British Columbia Children's Hospital, 4480 Oak Street, 1F Clinic, Vancouver, BC, V6H 3V4, Canada,
Curr Treat Options Cardiovasc Med. 2012 Oct;14(5):455-72. doi: 10.1007/s11936-012-0194-5.
Arrhythmias are an important cause of morbidity and mortality in children. Despite recent technological advances in treatment, pharmacologic therapy remains the most common treatment modality for pediatric arrhythmias. The choice of antiarrhythmic agent, the duration of therapy, and the dosing schedule depend on multiple factors including the recurrence risk and the arrhythmia burden (the latter being determined by the hemodynamic effect of the arrhythmia), and the frequency and duration of episodes. As with all pediatric medications, consideration must be given to the drug formulation, palatability, adverse effects and adherence issues. There are very few randomized trials available to guide the choice of therapy for pediatric arrhythmias, and thus treatment options often reflect physician or institutional preferences. Although various classification schemes exist, we classify antiarrhythmic agents based on their primary site of action: atrial muscle/accessory pathway (class IA, IC, and III agents); the atrioventricular node (beta-blockers, calcium channel blockers, digoxin, and class III agents); or ventricular muscle (class I and III agents). This type of categorization assists in the approach to treatment required for each type of arrhythmia encountered.
心律失常是儿童发病和死亡的重要原因。尽管近年来治疗技术取得了进展，但药物治疗仍然是小儿心律失常最常见的治疗方式。抗心律失常药物的选择、治疗持续时间和给药方案取决于多种因素，包括复发风险和心律失常负荷（后者由心律失常的血流动力学效应决定）以及发作频率和持续时间。与所有儿科药物一样，必须考虑药物剂型、适口性、不良反应和依从性问题。目前几乎没有随机试验可用于指导小儿心律失常治疗方案的选择，因此治疗选择往往反映医生或机构的偏好。虽然存在各种分类方案，但我们根据抗心律失常药物的主要作用部位对其进行分类：心房肌/附加通路（IA类、IC类和III类药物）；房室结（β受体阻滞剂、钙通道阻滞剂、地高辛和III类药物）；或心室肌（I类和III类药物）。这种分类有助于处理所遇到的每种类型心律失常所需的治疗方法。
