Kavey R E, Blackman M S, Sondheimer H M
Am Heart J. 1982 Oct;104(4 Pt 1):794-8. doi: 10.1016/0002-8703(82)90013-8.
Sudden death late after surgery for congenital heart disease is usually attributed to ventricular dysrhythmias, which may be difficult to suppress. In this study 19 consecutive patients with ventricular premature complexes (VPCs) documented by 24-hour ambulatory ECG monitoring were treated with phenytoin orally. Sixteen patients had undergone previous repair of the tetralogy of Fallot; three had undergone aortic valve surgery. Nine of these children had been unresponsive to previous antiarrhythmic therapy. Before treatment, four patients had ventricular tachycardia, three had couplets, six had frequent multiform VPCs, four had infrequent multiform VPCs, and two had frequent uniform VPCs. During treatment with phenytoin, the arrhythmia was decreased in all 19 patients and was completely suppressed in 15; the four remaining patients had only uniform VPCs on repeat ambulatory ECG. The mean serum level was 16.8 micrograms/ml (range 12 to 25 micrograms/ml) with a mean dose of 3.4 mg/kg (range 2 to 4 mg/kg). In one patient a skin rash led to discontinuation of phenytoin; no other side effects occurred. In summary, phenytoin was used to successfully suppress ventricular dysrhythmias in 19 consecutive patients with VPCs late after surgery for congenital heart disease. Phenytoin would appear to be the drug of choice for this patient group.
先天性心脏病手术后晚期猝死通常归因于心室性心律失常，这类心律失常可能难以抑制。在本研究中，对通过24小时动态心电图监测记录到有室性早搏（VPCs）的19例连续患者口服苯妥英钠进行治疗。16例患者曾接受法洛四联症修复术；3例接受过主动脉瓣手术。这些儿童中有9例对先前的抗心律失常治疗无反应。治疗前，4例患者有室性心动过速，3例有二联律，6例有多形性频发室性早搏，4例有多形性偶发室性早搏，2例有单形性频发室性早搏。在苯妥英钠治疗期间，所有19例患者的心律失常均有减轻，15例完全得到抑制；其余4例患者在重复动态心电图检查时仅发现单形性室性早搏。平均血清水平为16.8微克/毫升（范围为12至25微克/毫升），平均剂量为3.4毫克/千克（范围为2至4毫克/千克）。1例患者出现皮疹，导致停用苯妥英钠；未发生其他副作用。总之，苯妥英钠成功抑制了19例先天性心脏病手术后晚期有室性早搏的连续患者的室性心律失常。苯妥英钠似乎是该患者群体的首选药物。
