Krishna Mani Ram, Kunde Mohammed Farooq, Kumar Raman Krishna, Balaji Seshadri
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, AIMS Ponekkara (P.O), Kochi, 682041, India.
Department of Pediatrics (Cardiology), Oregon Health & Science University, Portland, OR, USA.
Pediatr Cardiol. 2019 Aug;40(6):1284-1288. doi: 10.1007/s00246-019-02149-5. Epub 2019 Jul 18.
Junctional ectopic tachycardia (JET) is the commonest tachyarrhythmia in the early post-operative period in children undergoing open-heart surgery. It frequently leads to hemodynamic instability and needs to be managed aggressively. Amiodarone is the first-line agent along with non-pharmacological interventions. We report our initial experience with the use of Ivabradine in post-operative JET. A retrospective case records review of children with post-operative JET during the period from June 2018 to May 2019 was performed. Eight patients with post-operative JET were treated with Ivabradine during this period. The first patient was initially treated with Amiodarone. All eight patients responded to Ivabradine. The initial response was rate control permitting overdrive pacing. One patient had recurrence of JET 10 h after Ivabradine and after return to sinus rhythm. Amiodarone was administered along with the second dose of Ivabradine resulting in remission to sinus rhythm. Ivabradine appears to be an effective alternative to Amiodarone in children with post-operative JET based on our initial clinical experience.
交界性异位性心动过速（JET）是接受心脏直视手术的儿童术后早期最常见的快速性心律失常。它常导致血流动力学不稳定，需要积极处理。胺碘酮是一线治疗药物，同时还需采取非药物干预措施。我们报告了使用伊伐布雷定治疗术后JET的初步经验。对2018年6月至2019年5月期间术后发生JET的儿童病例记录进行了回顾性分析。在此期间，8例术后JET患儿接受了伊伐布雷定治疗。首例患者最初接受胺碘酮治疗。所有8例患者对伊伐布雷定均有反应。最初的反应是心率得到控制，得以进行超速起搏。1例患者在使用伊伐布雷定后10小时且恢复窦性心律后JET复发。在给予第二剂伊伐布雷定的同时加用胺碘酮，结果恢复为窦性心律。根据我们的初步临床经验，伊伐布雷定似乎是治疗术后JET患儿的一种有效替代胺碘酮的药物。
