Willem-Alexander Children's Hospital-Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, Leiden, the Netherlands.
Sophia Children's Hospital-Erasmus Medical Center, Dr. Molewaterplein 40, Rotterdam, the Netherlands.
Pediatr Cardiol. 2021 Apr;42(4):883-890. doi: 10.1007/s00246-021-02556-7. Epub 2021 Jan 30.
The aim of the study is to compare the efficacy of flecainide, beta-blockers, sotalol, and verapamil in children with frequent PVCs, with or without asymptomatic VT. Frequent premature ventricular complexes (PVCs) and asymptomatic ventricular tachycardia (VT) in children with structurally normal hearts require anti-arrhythmic drug (AAD) therapy depending on the severity of symptoms or ventricular dysfunction; however, data on efficacy in children are scarce. Both symptomatic and asymptomatic children (≥ 1 year and < 18 years of age) with a PVC burden of 5% or more, with or without asymptomatic runs of VT, who had consecutive Holter recordings, were included in this retrospective multi-center study. The groups of patients receiving AAD therapy were compared to an untreated control group. A medication episode was defined as a timeframe in which the highest dosage at a fixed level of a single drug was used in a patient. A total of 35 children and 46 medication episodes were included, with an overall change in PVC burden on Holter of -4.4 percentage points, compared to -4.2 in the control group of 14 patients. The mean reduction in PVC burden was only significant in patients receiving flecainide (- 13.8 percentage points; N = 10; p = 0.032), compared to the control group and other groups receiving beta-blockers (- 1.7 percentage points; N = 18), sotalol (+ 1.0 percentage points; N = 7), or verapamil (- 3.9 percentage points; N = 11). The efficacy of anti-arrhythmic drug therapy on frequent PVCs or asymptomatic VTs in children is very limited. Only flecainide appears to be effective in lowering the PVC burden.
本研究旨在比较氟卡尼、β-受体阻滞剂、索他洛尔和维拉帕米在伴有或不伴有无症状性室性心动过速（VT）的频发室性早搏（PVCs）患儿中的疗效。结构正常的心脏患儿频发 PVCs 和无症状性 VT 需要抗心律失常药物（AAD）治疗，取决于症状或心室功能障碍的严重程度；然而，儿童疗效的数据非常有限。本回顾性多中心研究纳入了 PVC 负荷≥5%的伴有或不伴有无症状性 VT 发作的结构性正常心脏的症状性和无症状性儿童（≥1 岁且＜18 岁），以及连续进行 Holter 记录的患者。将接受 AAD 治疗的患者组与未治疗的对照组进行比较。一个药物治疗期定义为患者使用单一药物最高剂量的固定水平的时间段。共纳入 35 名儿童和 46 个药物治疗期，与 14 名未治疗的对照组患者相比，Holter 监测中的 PVC 负荷总体降低了-4.4 个百分点。仅在接受氟卡尼治疗的患者中（-13.8 个百分点；N=10；p=0.032），与对照组和接受β-受体阻滞剂（-1.7 个百分点；N=18）、索他洛尔（+1.0 个百分点；N=7）或维拉帕米（-3.9 个百分点；N=11）治疗的患者相比，PVC 负荷的降低有显著差异。AAD 治疗儿童频发 PVCs 或无症状性 VT 的疗效非常有限。只有氟卡尼似乎能有效降低 PVC 负荷。
