Cunningham Taylor, Uzun Orhan, Morris Rachel, Franciosi Sonia, Wong Amos, Jeremiasen Ida, Sherwin Elizabeth, Sanatani Shubhayan
Children's Heart Centre, British Columbia's Children's Hospital, 1F9, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
Department of Pediatric Cardiology, Noah's Ark Children's Hospital for Wales, University Hospital of Wales, Cardiff, Wales, UK.
Pediatr Cardiol. 2017 Dec;38(8):1633-1638. doi: 10.1007/s00246-017-1707-5. Epub 2017 Aug 24.
This retrospective study sought to determine the safety and effectiveness of flecainide in children with normal hearts and those with congenital heart disease (CHD) or cardiomyopathy (CMO). Baseline and follow-up data at two pediatric cardiology sites were queried (2000-2015); a total of 175 patients (20 with CHD and two with CMO) receiving flecainide were assessed. When comparing patients with CHD to those with normal hearts, patients with CHD were younger at diagnosis (median age 19 days; IQR 3-157.5 days vs normal heart patients median age 21 days; IQR 7-172 days, p = 0.4) and severe cardiac dysfunction was more prevalent (30% in CHD patients vs 8% in normal heart patients, p = 0.009). Treatment duration did not differ between the two groups (CHD patients median duration 52 weeks; IQR 27-91.5 weeks vs normal heart patients median duration 55 weeks; IQR 32-156 weeks, p = 0.5). Cardiac dysfunction resulting in flecainide discontinuation occurred in two patients (1%), one with CHD and one without. Three patients experienced proarrhythmia (2%) and there were no cardiac arrests during follow-up. There was one death in this cohort in a patient with severe CHD and an RSV infection (<1%). Arrhythmia control did not differ between the groups (90% in CHD patients vs 77% in normal heart patients, p = 0.2). Flecainide was well tolerated in this cohort, with fewer than 3% discontinuing medication due to flecainide-associated adverse events. Contrary to adult studies, there was no difference in the incidence of adverse events between patients with normal hearts and patients with CHD. Flecainide is a safe and effective antiarrhythmic medication, even for children with underlying CHD.
这项回顾性研究旨在确定氟卡尼对心脏正常的儿童以及患有先天性心脏病（CHD）或心肌病（CMO）的儿童的安全性和有效性。查询了两个儿科心脏病学中心的基线和随访数据（2000 - 2015年）；总共评估了175名接受氟卡尼治疗的患者（20名患有CHD，2名患有CMO）。将患有CHD的患者与心脏正常的患者进行比较时，患有CHD的患者诊断时年龄更小（中位年龄19天；四分位间距3 - 157.5天，而心脏正常的患者中位年龄21天；四分位间距7 - 172天，p = 0.4），并且严重心脏功能障碍更为普遍（CHD患者中为30%，心脏正常的患者中为8%，p = 0.009）。两组的治疗持续时间没有差异（CHD患者中位持续时间52周；四分位间距27 - 91.5周，而心脏正常的患者中位持续时间55周；四分位间距32 - 156周，p = 0.5）。导致停用氟卡尼的心脏功能障碍发生在两名患者中（1%），一名患有CHD，一名没有。三名患者出现心律失常（2%），随访期间没有心脏骤停发生。该队列中有一名患有严重CHD和呼吸道合胞病毒感染的患者死亡（<1%）。两组之间心律失常的控制情况没有差异（CHD患者中为90%，心脏正常的患者中为77%，p = 0.2）。该队列中氟卡尼耐受性良好，因氟卡尼相关不良事件停药的患者少于3%。与成人研究相反，心脏正常的患者和患有CHD的患者之间不良事件的发生率没有差异。氟卡尼是一种安全有效的抗心律失常药物，即使对于患有潜在CHD的儿童也是如此。
