Rochelson Ellis, Valdés Santiago O, Asadourian Vicken, Patel Raajen, Lemming Katherine, Howard Taylor S, Pham Tam Dan N, Miyake Christina Y, Kim Jeffrey J
Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Heart Rhythm. 2022 Mar;19(3):450-456. doi: 10.1016/j.hrthm.2021.11.021. Epub 2021 Nov 18.
Junctional ectopic tachycardia (JET) is a common arrhythmia after congenital heart disease surgery. There is variability in the choice of antiarrhythmic therapy, with amiodarone used commonly. Intravenous (IV) sotalol is a newly available agent that may be useful for JET.
The purpose of this study was to evaluate the safety and efficacy of IV sotalol for postoperative JET and compare outcomes with IV amiodarone.
This is a retrospective single-center study of all patients who received IV sotalol or IV amiodarone for postoperative JET at Texas Children's Hospital from December 15, 2015, to December 15, 2020. Data included antiarrhythmic efficacy, hemodynamics, and adverse effects. Successful JET control was defined as a decrease in JET rate to <170 beats/min (or decrease by >20%), or conversion to sinus rhythm, with persistent control over 24 hours without requiring alternative antiarrhythmics or mechanical support.
A total of 32 patients (median age 71 days; interquartile range 17-221 days) received IV amiodarone (n = 20 [62%]) or IV sotalol (n = 12 [38%]) for postoperative JET. Amiodarone was successful in treating JET in 75% of cases; sotalol was successful in 83%. The JET rate decreased faster over the first 90 minutes after a sotalol bolus (25 beats/min per hour) than after an amiodarone bolus (8 beats/min per hour) (P < .01); no heart rate difference was seen after 24 hours. Amiodarone infusion was discontinued early because of hypotension/bradycardia in 2 patients; this was not required in any patients receiving sotalol.
For children with postoperative JET, both IV sotalol and amiodarone are safe and efficacious. IV sotalol may lead to a faster improvement in heart rate.
交界性异位性心动过速（JET）是先天性心脏病手术后常见的心律失常。抗心律失常治疗的选择存在差异，胺碘酮是常用药物。静脉注射索他洛尔是一种新可用的药物，可能对JET有效。
本研究的目的是评估静脉注射索他洛尔治疗术后JET的安全性和有效性，并与静脉注射胺碘酮的结果进行比较。
这是一项回顾性单中心研究，纳入了2015年12月15日至2020年12月15日在德克萨斯儿童医院接受静脉注射索他洛尔或静脉注射胺碘酮治疗术后JET的所有患者。数据包括抗心律失常疗效、血流动力学和不良反应。成功控制JET的定义为JET心率降至<170次/分钟（或降低>20%），或转为窦性心律，持续控制24小时以上，无需使用其他抗心律失常药物或机械支持。
共有32例患者（中位年龄71天；四分位间距17 - 221天）接受静脉注射胺碘酮（n = 20 [62%]）或静脉注射索他洛尔（n = 12 [38%]）治疗术后JET。胺碘酮在75%的病例中成功治疗JET；索他洛尔的成功率为83%。静脉注射索他洛尔推注后最初90分钟内JET心率下降速度（每小时25次/分钟）比静脉注射胺碘酮推注后（每小时8次/分钟）更快（P < 0.01）；24小时后未见心率差异。2例患者因低血压/心动过缓提前停用胺碘酮输注；接受索他洛尔治疗的患者均未出现这种情况。
对于术后JET患儿，静脉注射索他洛尔和胺碘酮均安全有效。静脉注射索他洛尔可能使心率改善更快。
