Almomani Amr, Obeidat Mohammad A, Khassawneh Mohammad H, Maayeh Sakher M, Al-Malouf Khaled N
Pediatric Cardiology, Jordanian Royal Medical Services, Amman, JOR.
Internal Medicine, Jordanian Royal Medical Services, Amman, JOR.
Cureus. 2024 Nov 5;16(11):e73102. doi: 10.7759/cureus.73102. eCollection 2024 Nov.
Objectives The study evaluated the efficacy of antiarrhythmic pharmacotherapies in managing tachyarrhythmia episodes in pediatric patients with congenital heart diseases post-tricuspid valve repair, assessing reductions in haemodynamic parameters and symptomatic variables, and observing side effects. Methods From January 2020 to January 2024, this study reviewed data from 300 patients, aged up to 18 years, who experienced arrhythmia following cardiac surgery and received treatment with amiodarone, propranolol, or both. The information included demographic and anthropometric measures, haemodynamic parameters, and antiarrhythmic drugs used to treat arrhythmias before and after tricuspid valve repair. The study employed two validated symptomatic assessment scales: the four "A" symptomatic (4ASX) score and the New York Heart Association (NYHA) classification I-IV. We categorised the outcomes into two groups: the unresponsive cohort (Cohort I) and the responsive cohort (Cohort II). The study determined the antiarrhythmic efficacy by observing that the responsiveness group exhibited higher distribution rates in the lower heart rate category and higher decrementing rates in the tracked haemodynamics categories. The negative occurrence of at least one composited side effect of interest identified the safety significance profile for these three adopted antiarrhythmic interventions. The study adopted the threshold of 0.05 as the level of statistical significance. Results This study found that 32.33% exhibited clinical unresponsiveness to antiarrhythmic agents, while 67.67% achieved desired responsiveness. 38% used amiodarone as the choice antiarrhythmic medication, while 32.3% used propranolol. The study found significant distribution rates concerning heart rates, with 56.2% of patients with a heart rate of <100 bpm being responsive, compared to 38.1% in the unresponsive cohort. Symptomatic improvement was noted after transcatheter atrial septal defect closure in the 300 patients undergoing this procedure to address complications related to tricuspid regurgitation. Most of the adopted haemodynamic indices showed statistical significance decrementing rates in the responsiveness cohort compared to the unresponsiveness cohort. Conclusion Using antiarrhythmic pharmacotherapies during tricuspid valve repair had statistically significant responsiveness statuses against procedural arrhythmia, positive outcomes in symptomatic and haemodynamic monitored parameters, and a statistically significant noninferior safety profile regardless of the antiarrhythmic agent used (amiodarone, propranolol, or a combination of both.
目的 本研究评估抗心律失常药物疗法在治疗先天性心脏病三尖瓣修复术后小儿患者快速性心律失常发作中的疗效，评估血流动力学参数和症状变量的降低情况，并观察副作用。方法 2020年1月至2024年1月，本研究回顾了300名年龄在18岁以下、心脏手术后发生心律失常并接受胺碘酮、普萘洛尔或两者治疗的患者的数据。这些信息包括人口统计学和人体测量学指标、血流动力学参数，以及三尖瓣修复前后用于治疗心律失常的抗心律失常药物。本研究采用了两种经过验证的症状评估量表：四分“A”症状（4ASX）评分和纽约心脏协会（NYHA）I-IV级分类。我们将结果分为两组：无反应队列（队列I）和有反应队列（队列II）。本研究通过观察反应性组在较低心率类别中表现出较高的分布率以及在跟踪的血流动力学类别中表现出较高的递减率来确定抗心律失常疗效。至少一种感兴趣的复合副作用的阴性发生确定了这三种采用的抗心律失常干预措施的安全性意义概况。本研究采用0.05的阈值作为统计学显著性水平。结果 本研究发现，32.33%的患者对抗心律失常药物表现出临床无反应，而67.67%的患者达到了预期的反应。38%的患者选择胺碘酮作为抗心律失常药物，而32.3%的患者使用普萘洛尔。本研究发现心率分布率有显著差异，心率<100次/分钟的患者中，56.2%有反应，而无反应队列中的这一比例为38.1%。在300名接受经导管房间隔缺损封堵术以解决与三尖瓣反流相关并发症的患者中，术后症状有所改善。与无反应队列相比，大多数采用的血流动力学指标在反应性队列中显示出统计学上显著的递减率。结论 在三尖瓣修复术中使用抗心律失常药物疗法对手术相关心律失常具有统计学上显著的反应状态，在症状和血流动力学监测参数方面有积极结果，并且无论使用何种抗心律失常药物（胺碘酮、普萘洛尔或两者联合），都具有统计学上显著的非劣效安全性概况。
