Costello John P, He Dingchao, Greene Elizabeth A, Berul Charles I, Moak Jeffrey P, Nath Dilip S
Division of Cardiovascular Surgery, Children's National Medical Center, Washington, DC, USA.
Congenit Heart Dis. 2014 Mar-Apr;9(2):E46-50. doi: 10.1111/chd.12070. Epub 2013 May 7.
A full-term male neonate presented with cyanosis upon delivery and was subsequently diagnosed with d-transposition of the great arteries, ventricular septal defect, and restrictive atrial septal defect. Following initiation of intravenous prostaglandins and balloon atrial septostomy, an arterial switch operation was performed on day 3 of life. The postoperative course was complicated by intractable ventricular tachycardia that was refractory to lidocaine, amiodarone, esmolol, fosphenytoin, and mexiletine drug therapy. Ventricular tachycardia was suppressed with overdrive atrial pacing but recurred upon discontinuation. Seven weeks postoperatively, radiofrequency catheter ablation was performed due to hemodynamically compromising persistent ventricular tachycardia refractory to medical therapy. The ventricular tachycardia was localized to the inferior-lateral right ventricular outlet septum. The procedure was successful without complications or recurrence. Antiarrhythmics were discontinued after the ablation procedure. Seven days after the ablation, a different, slower fascicular rhythm was noted to compete with the infant's sinus rhythm. This was consistent with the preablation amiodarone having reached subtherapeutic levels given its very long half-life. The patient was restarted on oral beta blockers and amiodarone. The patient was subsequently discharged home in predominantly sinus rhythm with intermittent fascicular rhythm.
一名足月儿男婴出生时即出现青紫，随后被诊断为大动脉d型转位、室间隔缺损和限制性房间隔缺损。在开始静脉输注前列腺素和球囊房间隔造口术后，于出生后第3天进行了动脉调转手术。术后病程因顽固性室性心动过速而复杂化，利多卡因、胺碘酮、艾司洛尔、磷苯妥英钠和美西律药物治疗均无效。室性心动过速通过超速心房起搏得以抑制，但在起搏停止后复发。术后7周，由于药物治疗无效且血流动力学受影响的持续性室性心动过速，进行了射频导管消融术。室性心动过速定位于下外侧右心室流出道间隔。手术成功，无并发症或复发。消融术后停用抗心律失常药物。消融术后7天，发现一种不同的、较慢的束支节律与婴儿的窦性心律竞争。鉴于胺碘酮半衰期很长，这与消融术前其达到亚治疗水平一致。患者重新开始口服β受体阻滞剂和胺碘酮。患者随后以主要为窦性心律伴间歇性束支节律的状态出院回家。
