All authors: Departments of Cardiovascular Surgery, Pediatric Cardiology, and Medical English Communications Center, University of Tsukuba, Tsukuba, Japan.
Pediatr Crit Care Med. 2018 Aug;19(8):713-717. doi: 10.1097/PCC.0000000000001573.
Junctional ectopic tachycardia is a supraventricular tachyarrhythmia with atrioventricular dissociation that causes life-threatening postsurgical conditions in pediatric heart patients. This study evaluates the efficacy of landiolol hydrochloride for managing junctional ectopic tachycardia.
A single-center retrospective study.
PICU at the university hospital.
Of 561 pediatric patients who underwent open-heart surgery between 2006 and 2017, 10 patients developed sustained junctional ectopic tachycardia and were selected for landiolol treatment.
None.
Landiolol decreased mean heart rate significantly from 206.1 ± 14.5 to 158.0 ± 8.6 beats/min within 2 hours after administration (p < 0.01). Mean time to achieve 20% heart rate reduction was 2.1 ± 0.5 hours. Systolic blood pressure between pre and post landiolol administration did not change significantly (72.6 ± 5.9 to 79.7 ± 6.2 mm Hg). Once junctional heart rate was sufficiently suppressed, atrioventricular sequential pacing was introduced to stabilize hemodynamics. Nine of 10 cases (90%) had atrioventricular sequential pacing to maintain appropriate heart rate and restore atrioventricular synchronicity under suppressed junctional heart rate. Subsequently, eight of 10 cases (80%) were converted to regular sinus rhythm within 24 hours after starting landiolol administration. The average time to achieve sinus rhythm conversion was 7.9 ± 3.4 hours.
Landiolol rapidly suppresses junctional heart rate in junctional ectopic tachycardia after pediatric heart surgery without significant blood pressure compromises. Subsequent atrioventricular sequential pacing was effective at restoring atrioventricular synchronicity and stabilizing hemodynamics. Combining junctional rate control with landiolol and atrioventricular sequential pacing is therefore suggested as a promising option for prompt management of postoperative junctional ectopic tachycardia.
交界性心动过速是一种伴有房室分离的室上性心动过速，可导致儿科心脏病患者术后出现危及生命的情况。本研究评估盐酸拉贝洛尔治疗交界性心动过速的疗效。
单中心回顾性研究。
大学医院的 PICU。
2006 年至 2017 年间，561 例接受心脏直视手术的儿科患者中，有 10 例出现持续性交界性心动过速，选择接受拉贝洛尔治疗。
无。
拉贝洛尔在给药后 2 小时内使平均心率从 206.1±14.5 次/分显著降低至 158.0±8.6 次/分（p<0.01）。达到心率降低 20%的平均时间为 2.1±0.5 小时。拉贝洛尔给药前后收缩压无明显变化（72.6±5.9 至 79.7±6.2mmHg）。一旦交界性心率得到充分抑制，即引入房室顺序起搏以稳定血液动力学。10 例中有 9 例（90%）在抑制交界性心率下采用房室顺序起搏以维持适当的心率并恢复房室同步性。随后，在开始拉贝洛尔给药后 24 小时内，10 例中有 8 例（80%）转为窦性心律。实现窦性心律转复的平均时间为 7.9±3.4 小时。
盐酸拉贝洛尔可迅速抑制小儿心脏手术后交界性心动过速的交界性心率，而不会显著降低血压。随后的房室顺序起搏可有效恢复房室同步性并稳定血液动力学。因此，建议将交界性心率控制与拉贝洛尔和房室顺序起搏相结合，作为治疗术后交界性心动过速的一种有前途的选择。
