Miyake Kentaro, Fujita Yoshihito, Yoshizawa Saya, Tomita Maiko, Miyazu Mitsunori, Sento Yoshiki, Yoshimura Shinichiro, Sobue Kazuya
Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Anesthesiology, Aichi Medical University School of Medicine, 1-1 Karimata Yazako Nagakute, Aichi, 480-1195, Japan.
J Anesth. 2016 Apr;30(2):331-6. doi: 10.1007/s00540-015-2119-4. Epub 2015 Dec 23.
The onset of tachyarrhythmia after the Fontan procedure (total cavopulmonary connection; TCPC) should be considered a medical emergency. Landiolol is an ultra-short-acting β1-selective blocker whose effect on tachyarrhythmia after TCPC is unclear. We evaluated the efficacy and safety of landiolol for tachyarrhythmia after TCPC. Consecutive patients undergoing TCPC were enrolled from January 2007 to December 2011. Of 435 pediatric open heart surgeries, 28 patients underwent TCPC. Of the 28 patients, 13 were treated with landiolol for critical tachyarrhythmia. Excluding three patients who received landiolol during surgery, we investigated the remaining 10 patients and statistical analysis was performed without a 10-year-old patient as outlier. The median age was 4.08 years. The subjects comprised five patients with sinus tachycardia, four with junctional ectopic tachycardia and one with paroxysmal supraventricular tachycardia. The initial dose was 4.7 ± 2.3 μg/kg/min, without a loading dose. Landiolol reduced the heart rate from 151.8 ± 23.2 at the start to 132.9 ± 20.0 at 1 h and 126.1 ± 24.9 at 2 h (P < 0.01 and P < 0.01, respectively), without blood pressure decrease (P = 0.235). Landiolol was effective in treating critical tachyarrhythmia without hemodynamic deterioration. We believe that landiolol is a promising option for postoperative tachyarrhythmia after the Fontan procedure.
在Fontan手术（全腔静脉肺动脉连接术；TCPC）后发生快速心律失常应被视为医疗紧急情况。兰地洛尔是一种超短效β1选择性阻滞剂，其对TCPC术后快速心律失常的作用尚不清楚。我们评估了兰地洛尔治疗TCPC术后快速心律失常的有效性和安全性。2007年1月至2011年12月连续纳入接受TCPC的患者。在435例小儿心脏直视手术中，28例接受了TCPC。在这28例患者中，13例因严重快速心律失常接受了兰地洛尔治疗。排除3例在手术期间接受兰地洛尔治疗的患者，我们对其余10例患者进行了研究，并在不将一名10岁患者作为异常值的情况下进行了统计分析。中位年龄为4.08岁。研究对象包括5例窦性心动过速患者、4例交界性异位性心动过速患者和1例阵发性室上性心动过速患者。初始剂量为4.7±2.3μg/kg/min，无负荷剂量。兰地洛尔使心率从开始时的151.8±23.2次/分钟降至1小时时的132.9±20.0次/分钟和2小时时的126.1±24.9次/分钟（分别为P<0.01和P<0.01），血压无下降（P=0.235）。兰地洛尔在治疗严重快速心律失常时有效且不伴有血流动力学恶化。我们认为兰地洛尔是Fontan手术后术后快速心律失常的一个有前景的选择。
