Yozgat Can Yilmaz, Yesilbas Osman, Iscan Akin, Yurtsever Ismail, Temur Hafize Otcu, Bayramova Nigar, Ergun Gokce, Tekin Nur, Yozgat Yilmaz
Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Department of Pediatric Critical Care Medicine, Bezmialem Vakif University, Istanbul, Turkey.
J Pediatr Intensive Care. 2020 Sep 28;11(1):72-76. doi: 10.1055/s-0040-1715851. eCollection 2022 Mar.
Sudden cardiac arrest (SCA) is the sudden cessation of regular cardiac activity so that the victim becomes unresponsive, with no signs of circulation and no normal breathing. Asystole, ventricular tachycardia (VT), ventricular fibrillation (VF), and pulseless electrical activity are the underlying rhythm disturbances in the pediatric age group. If appropriate interventions (cardiopulmonary resuscitation-CPR and/or defibrillation or cardioversion) are not performed rapidly, this condition progresses to sudden death. There have not been many reported cases of the approach and treatment of cardiac arrhythmias after SCA. Herein, we would like to report a case of a 15-year-old female patient with dilated cardiomyopathy (DCM) who was admitted to our clinic a year ago, and while her left ventricular systolic functions were improved, SCA suddenly occurred. Since the SCA event occurred in another city, intravenous treatment of amiodarone was done immediately and was switch to continuous infusion dose of amiodarone until the patient arrived at our institution's pediatric intensive care unit (PICU) 3 hours later. During the patient's 20-day PICU hospitalization, she developed pulseless VT and VF from time to time. The patient's pulseless VT and VF attacks were brought under control by the use of a defibrillator and added antiarrhythmic drugs (amiodarone, flecainide, esmolol, and propafenone). Intriguingly, therapy-resistance bigeminy with premature ventricular contractions (PVCs) continued despite all these treatments. The patient did not have adequate blood pressure measured by invasive arterial blood pressure monitoring while having bigeminy PVCs. The intermittent bigeminy PVCs ameliorated rapidly after intermittent boluses of lidocaine. In the end, multiple antiarrhythmic therapies and intermittent bolus lidocaine doses were enough to bring her cardiac arrhythmias after SCA under control. This case illustrates that malign PVC's should be taken very seriously, since they may predispose to the development of VT or VF. Also, this case highlights the importance of close vigilance of arterial pressure tracings of patients with bigeminy PVCs which develop after SCA and should not be accepted as normal.
心脏骤停（SCA）是指心脏正常活动突然停止，导致患者失去反应，没有循环迹象且呼吸不正常。心搏停止、室性心动过速（VT）、心室颤动（VF）和无脉电活动是儿童年龄组潜在的节律紊乱。如果不迅速进行适当干预（心肺复苏 - CPR和/或除颤或复律），这种情况会发展为猝死。关于心脏骤停后心律失常的处理和治疗，报道的病例并不多。在此，我们报告一例15岁扩张型心肌病（DCM）女性患者，该患者一年前入住我们诊所，虽然其左心室收缩功能有所改善，但突然发生了心脏骤停。由于心脏骤停事件发生在另一个城市，立即进行了静脉注射胺碘酮治疗，并改为胺碘酮持续输注剂量，直到3小时后患者到达我们机构的儿科重症监护病房（PICU）。在患者入住PICU的20天期间，她不时出现无脉性室性心动过速和心室颤动。通过使用除颤器和添加抗心律失常药物（胺碘酮、氟卡尼、艾司洛尔和普罗帕酮），患者的无脉性室性心动过速和心室颤动发作得到了控制。有趣的是，尽管进行了所有这些治疗，仍持续存在对治疗耐药的室性早搏二联律。在出现室性早搏二联律时，通过有创动脉血压监测测量，患者没有足够的血压。静脉注射利多卡因后，间歇性室性早搏二联律迅速改善。最后，多种抗心律失常治疗和间歇性利多卡因推注剂量足以控制她心脏骤停后的心律失常。这个病例表明，恶性室性早搏应引起高度重视，因为它们可能易导致室性心动过速或心室颤动的发生。此外，这个病例突出了对心脏骤停后出现室性早搏二联律的患者密切监测动脉压曲线的重要性，不应将其视为正常情况。
