Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy.
Pediatr Cardiol. 2023 Jun;44(5):1040-1049. doi: 10.1007/s00246-023-03162-5. Epub 2023 Apr 24.
Atrioventricular reentrant tachycardia (AVRT) is the most common form of supraventricular tachycardia in newborns. AVRT is sometimes refractory to conventional antiarrhythmic therapy. We describe our experience about the use of the triple combination of flecainide + propranolol + amiodarone as third-line regimen for refractory and recurrent AVRT in newborns. We considered a series of 14 patients who had failed both first-line and second-line therapy and were treated using the combination of flecainide + propranolol + amiodarone. Transoesophageal electrophysiologic study (TES) was performed to test the effectiveness of medical therapy during hospitalization and to try to reduce the amount of therapy, after amiodarone wash-out, before 1 year of age. TES was repeated at 1 year of age to test the spontaneous resolution of the arrhythmia after treatment discontinuation. Rhythm control was achieved in all 14 patients. At a mean age of 9.3 ± 2 months, AVRT was not inducible by TES in 11/12 amiodarone-free patients. At a mean age of 14.1 ± 3 months, AVRT was still inducible in 7/12 patients after interrupting the entire antiarrhythmic therapy (58.3%). Triple combination was effective as third-line option to suppress AVRT refractory to single and double antiarrhythmic therapy, with no significant adverse events. Our experience suggests that triple therapy could be maintained for a short-term treatment, discontinuing amiodarone before 1 year of age to avoid long-term side effects. Newborns who needed triple therapy appear to have a lower chance of accessory pathway disappearance at 1 year of age. TES could be useful for risk stratification of recurrences at the time of drug discontinuation in infants considered to be at higher risk of recurrent AVRT.
房室折返性心动过速（AVRT）是新生儿中最常见的室上性心动过速形式。AVRT 有时对常规抗心律失常治疗有抗性。我们描述了我们使用氟卡尼+普萘洛尔+胺碘酮三联疗法作为新生儿难治性和复发性 AVRT 的三线治疗方案的经验。我们考虑了一系列 14 名患者，他们在一线和二线治疗均失败，并使用氟卡尼+普萘洛尔+胺碘酮联合治疗。在住院期间进行经食管电生理研究（TES）以测试药物治疗的有效性，并在胺碘酮洗脱后尝试减少治疗量，以在 1 岁之前。在 1 岁时重复 TES，以测试治疗停药后心律失常的自发缓解。所有 14 名患者均实现了节律控制。在平均年龄为 9.3±2 个月时，12 名无胺碘酮患者中有 11 名经 TES 无法诱导 AVRT。在平均年龄为 14.1±3 个月时，在中断整个抗心律失常治疗后，7/12 名患者（58.3%）仍可诱导 AVRT。在单一和双重抗心律失常治疗有抗性的情况下，三联疗法作为三线选择有效地抑制 AVRT，没有明显的不良事件。我们的经验表明，三联疗法可以作为短期治疗，在 1 岁之前停止胺碘酮，以避免长期副作用。需要三联疗法的新生儿在 1 岁时旁路消失的可能性较低。在考虑 AVRT 复发风险较高的婴儿中，TES 可用于药物停药时复发的风险分层。
