Moak J P, Smith R T, Garson A
Am Heart J. 1987 Jan;113(1):179-85. doi: 10.1016/0002-8703(87)90027-5.
Our experience with the use of five new antiarrhythmic drugs for treating life-threatening arrhythmias in children will be briefly reviewed. Prevention of recurrent episodes of atrial flutter with digoxin and local anesthetic antiarrhythmic drugs often is only moderately successful, benefiting 65% of patients. Amiodarone is particularly useful for those patients who cannot be controlled on this regimen. We caution that the heart rate be monitored carefully when therapy with amiodarone is initiated in patients likely to have sick sinus syndrome. We have found mexiletine useful for controlling significant ventricular arrhythmias in patients with congenital heart disease. Likewise, 79% (11 of 14) of patients with ventricular tachycardia treated with amiodarone were well controlled. However, the range of disease categories (congenital heart disease, myocarditis, cardiomyopathy) in which amiodarone is effective is much broader than for mexiletine. Although other investigators have used amiodarone successfully for controlling supraventricular tachycardia in the Wolff-Parkinson-White syndrome or secondary to concealed accessory AV connections, we recommend surgical ablation. Propafenone has significantly improved our ability to control postoperative JET. Although JET is self-limited in duration and spontaneously remits, it frequently produces life-threatening hemodynamic compromise in the postoperative setting. Propafenone slows the ventricular rate into a range in which AV sequential pacing may be instituted. Generally, after 24 to 72 hours, the patient may be quickly weaned from propafenone. Chronic incessant supraventricular tachycardia (SVT) is frequently associated with a dilated cardiomyopathy. The two most common mechanisms of incessant SVT are PJRT and AET. We have found encainide and ethmozine extremely effective in suppressing tachycardia episodes in PJRT and AET, respectively. Medical therapy has been associated with few side effects.
我们将简要回顾使用五种新型抗心律失常药物治疗儿童危及生命的心律失常的经验。使用地高辛和局部麻醉抗心律失常药物预防心房扑动复发，成功率通常仅为中等水平，65%的患者受益。胺碘酮对那些在此治疗方案下无法得到控制的患者特别有用。我们提醒，在可能患有病态窦房结综合征的患者开始使用胺碘酮治疗时，应仔细监测心率。我们发现美西律对控制先天性心脏病患者的严重室性心律失常有用。同样，接受胺碘酮治疗的室性心动过速患者中有79%（14例中的11例）得到了良好控制。然而，胺碘酮有效的疾病类别范围（先天性心脏病、心肌炎、心肌病）比美西律广泛得多。尽管其他研究者已成功使用胺碘酮控制预激综合征或隐匿性房室旁道引起的室上性心动过速，但我们建议进行手术消融。普罗帕酮显著提高了我们控制术后交界性异位心动过速的能力。尽管交界性异位心动过速持续时间有限且可自发缓解，但在术后情况下它经常导致危及生命的血流动力学损害。普罗帕酮可将心室率减慢至可进行房室顺序起搏的范围。一般来说，24至72小时后，患者可迅速停用普罗帕酮。慢性持续性室上性心动过速（SVT）常与扩张型心肌病相关。持续性SVT最常见的两种机制是持续性交界性反复性心动过速（PJRT）和房性异位性心动过速（AET）。我们发现恩卡尼和乙吗噻嗪分别对抑制PJRT和AET的心动过速发作极为有效。药物治疗的副作用很少。
