Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
J Cardiovasc Electrophysiol. 2021 Aug;32(8):2207-2215. doi: 10.1111/jce.15077. Epub 2021 May 16.
Sotalol and flecainide are used as second line agents in children for the treatment of supraventricular arrhythmias (SA) refractory to anti-beta adrenergic antiarrhythmics or digoxin. Efficacy and adverse events in this cohort have not been well described. Here, we report our institutional experience of second line treatment initiation for SA in children.
Utilizing an institutional database, 247 patients initiated on sotalol and 81 patients initiated on flecainide were identified. Congenital heart disease (CHD) was present in 40% of patients. Arrhythmia-free discharge on single or dual agent therapy (in combination with other antiarrhythmics) was 87% for sotalol and 91% for flecainide. Neither age, sex, dosing, presence of CHD nor arrhythmia subtype were associated with alterations in in-hospital efficacy. Compared to baseline, QTc intervals in sotalol patients (436 [416-452 ms] vs. 415 [400-431 ms], p < .01) and QRS intervals in flecainide patients (75 [68-88 ms] vs. 62 [56-71 ms], p < .01) were prolonged. Dose reduction or discontinuation due to QRS prolongation occurred in 9% of patients on flecainide. QTc prolongation resulting in dose reduction/discontinuation of sotalol was encountered in 9 patients (4%) and death with documented torsade de pointes in 2 patients (1%), with 9 of 11 patients having underlying CHD.
In children requiring second line agents for treatment of SA, both sotalol and flecainide appear to be highly efficacious. Although predominantly safe in otherwise healthy patients, electrocardiogram changes can occur and children with underlying cardiac disease may have an increased risk of adverse events and rhythm-related side effects during initiation.
索他洛尔和氟卡尼被用作儿童治疗室上性心律失常（SA）的二线药物，适用于对抗β肾上腺素能抗心律失常药或地高辛无效的患者。在该队列中，尚未很好地描述其疗效和不良事件。在这里，我们报告了我们机构在儿童中使用二线药物治疗 SA 的经验。
利用机构数据库，确定了 247 例开始使用索他洛尔和 81 例开始使用氟卡尼的患者。40%的患者存在先天性心脏病（CHD）。单药或双联药物（联合其他抗心律失常药物）治疗的无心律失常出院率为索他洛尔组 87%，氟卡尼组 91%。年龄、性别、剂量、CHD 存在与否以及心律失常类型均与住院期间疗效的变化无关。与基线相比，索他洛尔患者的 QTc 间期（436 [416-452 ms] 比 415 [400-431 ms]，p < 0.01）和氟卡尼患者的 QRS 间期（75 [68-88 ms] 比 62 [56-71 ms]，p < 0.01）均延长。9%的氟卡尼患者因 QRS 延长而减少剂量或停药。9 例（4%）患者因 QTc 延长而减少剂量/停药，2 例（1%）患者因尖端扭转型室性心动过速死亡，11 例中有 9 例存在基础 CHD。
在需要二线药物治疗 SA 的儿童中，索他洛尔和氟卡尼均显示出高度疗效。在其他方面健康的患者中，虽然主要是安全的，但可能会发生心电图变化，患有基础心脏病的儿童在开始治疗时可能会增加发生不良事件和与节律相关的副作用的风险。
