Sharma Dhruva, Subramaniam Ganapathy, Sharma Neha
Department of Cardiothoracic and Vascular Surgery, SMS Medical College & Attached Hospitals, J L N Marg, Jaipur, Rajasthan 302001 India.
Institute of Heart and Lung Transplant and Mechanical Circulatory Support, MGM Healthcare, No. 72, Nelson Manickam Road, Aminjikarai, Chennai, Tamil Nadu 600029 India.
Indian J Thorac Cardiovasc Surg. 2021 May;37(3):323-325. doi: 10.1007/s12055-020-01056-2. Epub 2020 Oct 7.
Cardiac surgeries especially involving crux of the heart as performed in tetralogy of Fallot (TOF) and pulmonary stenosis are mainly responsible for junctional ectopic tachycardia (JET). Diversified antiarrhythmic agents have been used in an impressive way to treat JET but showed suboptimal efficacy and varied associated adverse effects. But, ivabradine has proved as final crusader for its treatment. We report our initial experience of 4 cases in last 6 months with ivabradine in the management of postoperative JET. Encouraged by various reports and our increasing experience with ivabradine in heart failure population, we have moved to ivabradine as the first drug of choice for postoperative JET. Bradycardia was the only significant adverse effect in our series. The availability of atrial and ventricular pacing wires or at least transvenous temporary pacing should be ensured before starting ivabradine.
心脏手术，尤其是法洛四联症（TOF）和肺动脉狭窄手术中涉及心脏十字交叉处的手术，是导致交界性异位性心动过速（JET）的主要原因。多种抗心律失常药物已被大量用于治疗JET，但疗效欠佳且不良反应各异。不过，伊伐布雷定已被证明是治疗JET的最终“斗士”。我们报告了过去6个月中4例使用伊伐布雷定治疗术后JET的初步经验。受各种报告以及我们在心力衰竭患者中使用伊伐布雷定经验不断增加的鼓舞，我们已将伊伐布雷定作为术后JET的首选药物。在我们的系列病例中，心动过缓是唯一显著的不良反应。在开始使用伊伐布雷定之前，应确保有房、室起搏导线，或至少有经静脉临时起搏设备。
