Kamali Hacer, Öztürk Erkut, Çiftçi Mehtap, Kafali Hasan Candas, Şahin Gülhan Tunca, Haydin Sertaç, Hatemi Ali Can, Tanıdır İbrahim Cansaran, Güzeltaş Alper, Ergül Yakup
Department of Pediatric Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences Istanbul Turkey.
Department of Pediatric Cardiology Istanbul Başakşehir Cam and Sakura Training and Research Hospital, University of Health Sciences Istanbul Turkey.
J Arrhythm. 2024 Oct 8;40(6):1473-1480. doi: 10.1002/joa3.13155. eCollection 2024 Dec.
Although amiodarone is traditionally used in the treatment of postoperative junctional ectopic tachycardia (JET), the search for new treatments is ongoing. We present our experience with ivabradine at two medical centers.
Between January 2022 and January 2023, patients who developed JET after pediatric cardiac surgery were prospectively followed up and documented. The diagnosis of JET was made with the support of the electrophysiology team and treatment was based primarily on whether JET disrupted hemodynamics.
This study was conducted at two high-volume centers, which record a total of 1130 pediatric cardiac surgeries within a year. The study recruited 26 patients with median heart rate 180 beats per minute, and 10 (38%) patients had impaired hemodynamics. Out of the 26 study participants, 14 (54%) cases were treated with ivabradine alone, 10 (38%) cases were treated with amiodarone + ivabradine, and 2 patients (8%) with high heart rates and prolonged junctional arrhythmia were treated with ivabradine and flecainide. The median time to ventricular rate control was 12 h, and the median time to sinus rhythm conversion was 55.5 h. No ivabradine-related side effects were observed in any of the patients, and no patient experienced JET recurrence after discontinuing treatment.
Ivabradine seems to be a safe and effective medical treatment that can be used as the primary treatment in patients with stable hemodynamics, as an adjunctive therapy to amiodarone in patients with impaired hemodynamics.
尽管胺碘酮传统上用于治疗术后交界性异位性心动过速（JET），但对新治疗方法的探索仍在进行中。我们介绍了在两个医疗中心使用伊伐布雷定的经验。
2022年1月至2023年1月，对小儿心脏手术后发生JET的患者进行前瞻性随访并记录。JET的诊断在电生理团队的支持下做出，治疗主要基于JET是否扰乱血流动力学。
本研究在两个大型中心进行，这两个中心一年内共记录了1130例小儿心脏手术。该研究招募了26例患者，心率中位数为每分钟180次，其中10例（38%）患者血流动力学受损。在26名研究参与者中，14例（54%）仅接受伊伐布雷定治疗，10例（38%）接受胺碘酮+伊伐布雷定治疗，2例（8%）心率高且交界性心律失常持续时间长的患者接受伊伐布雷定和氟卡尼治疗。心室率控制的中位时间为12小时，窦性心律转复的中位时间为55.5小时。所有患者均未观察到与伊伐布雷定相关的副作用，且无患者在停药后出现JET复发。
伊伐布雷定似乎是一种安全有效的药物治疗方法，可用于血流动力学稳定患者的一线治疗，也可作为血流动力学受损患者胺碘酮的辅助治疗。
