Ergül Yakup, Özyılmaz İsa, Saygı Murat, Tola Hasan Tahsin, Akdeniz Celal, Tuzcu Volkan
Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiocvascular Surgery Training and Research Hospital, Istanbul, Turkey.
Turk Kardiyol Dern Ars. 2015 Oct;43(7):607-12. doi: 10.5543/tkda.2015.30759.
This study aimed to evaluate the efficacy of flecainide therapy in neonates and infants with drug resistant incessant supraventricular tachycardia.
The study included 11 neonates and infants who received medical and/or ablation therapy between January 2010 and December 2013. Mean patient age and weight were 101.6 ± 96 days and 5.3 ± 1.9 kg respectively. Of the 12 patients, 5 underwent ablation between January 2010 and December 2011, and 6 were treated medically between January 2012 and December 2013. Mean follow-up time was 18 months (6 months-4 years).
The antiarrhythmic agent flecainide only became available in Turkey in 2012, and the most noteworthy point was its addition to the therapy administered prior to ablation (adenosine, esmolol-propranolol, propafenone, amiodarone and cardioversion). In all 6 patients admitted between January 2012 and December 2013, refractory SVT was successfully treated with the administration of a triple therapy regimen of esmolol-propranolol, amiodarone and flecainide. One patient with myocarditis developed an atrial flutter complicated by a concealed accessory pathway and was put on extracorporeal membrane oxygenation (ECMO) support due to cardiopulmonary failure. The SVT was terminated, but the patient died on the fifteenth day of ECMO support. One patient with recurrent tachycardia, who had previously undergone ablation for a complex cardiac anomaly and Wolf-Parkinson-White syndrome, was treated with ablation again. No recurrence of tachycardia was observed in any of the other 9 patients.
It appears that the use of propranolol-esmolol and amiodarone combined with flecainide in the medical treatment of drug-resistant SVT may reduce the need for ablation in critical neonates and infants.
本研究旨在评估氟卡尼治疗新生儿和婴儿耐药性持续性室上性心动过速的疗效。
该研究纳入了2010年1月至2013年12月期间接受药物和/或消融治疗的11名新生儿和婴儿。患者的平均年龄和体重分别为101.6±96天和5.3±1.9千克。在这12名患者中，5例于2010年1月至2011年12月接受了消融治疗，6例于2012年1月至2013年12月接受了药物治疗。平均随访时间为18个月（6个月至4年）。
抗心律失常药物氟卡尼于2012年才在土耳其上市，最值得注意的是它被添加到消融术前使用的治疗方案（腺苷、艾司洛尔-普萘洛尔、普罗帕酮、胺碘酮和心脏复律）中。在2012年1月至2013年12月收治的所有6例患者中，难治性室上性心动过速通过艾司洛尔-普萘洛尔、胺碘酮和氟卡尼三联疗法成功得到治疗。1例心肌炎患者发生心房扑动并伴有隐匿性旁路，因心肺衰竭接受体外膜肺氧合（ECMO）支持。室上性心动过速终止，但患者在ECMO支持的第15天死亡。1例复发性心动过速患者，此前因复杂心脏畸形和预激综合征接受过消融治疗，再次接受了消融治疗。其他9例患者均未观察到心动过速复发。
在耐药性室上性心动过速的药物治疗中，使用普萘洛尔-艾司洛尔和胺碘酮联合氟卡尼似乎可以减少危重新生儿和婴儿的消融需求。
