Pfammatter J P, Paul T, Lehmann C, Kallfelz H C
Department of Pediatric Cardiology, Children's Hospital, Hannover Medical School, Germany.
J Am Coll Cardiol. 1995 Oct;26(4):1002-7. doi: 10.1016/0735-1097(95)00268-3.
This study sought to assess the efficacy of oral sotalol for various arrhythmias in pediatric patients and to evaluate the incidence of proarrhythmia and systemic side effects.
Sotalol is a beta-adrenergic blocking agent with additional class III antiarrhythmic properties. Experience in pediatric patients is limited. Data concerning the incidence of proarrhythmia in children are lacking.
Seventy-one pediatric patients (mean age 7.3 years) with various supraventricular and ventricular tachyarrhythmias were treated with oral sotalol. All the patients were admitted to the hospital for initiation of sotalol therapy. Antiarrhythmic and proarrhythmic effects of sotalol were assessed by daily surface electrocardiograms (ECGs) during the in-hospital phase and by serial Holter monitoring.
Sotalol was either completely (27 [66%] of 41 patients) or partially effective (11 [27%] of 41) in 38 (93%) of 41 patients with supraventricular reentrant tachycardias. In patients with atrial flutter predominantly after operation for congenital heart disease, sotalol was effective in 84% of patients (completely in 9 of 19 and partially in 7 of 19). Ventricular tachycardia was completely (3 of 11) or partially (4 of 11) controlled in 64% of children. Proarrhythmia occurred in seven patients (10%) and consisted of symptomatic bradycardia from sinoatrial block and high grade atrioventricular (AV) block, respectively, in two children; asymptomatic high grade AV block in one; torsade de pointes in one; and relevant increased ventricular ectopic activity in three. Proarrhythmia required drug discontinuation in four patients. Mean duration of treatment for all patients was 18 months (range 1 to 40).
Sotalol was an effective antiarrhythmic drug for a wide range of pediatric tachyarrhythmias. The considerable number of patients with proarrhythmic effects indicates the need for initiation of treatment on an inpatient basis and close monitoring by serial Holter electrocardiography.
本研究旨在评估口服索他洛尔对儿科患者各种心律失常的疗效，并评估致心律失常作用及全身性副作用的发生率。
索他洛尔是一种兼具Ⅲ类抗心律失常特性的β肾上腺素能阻滞剂。儿科患者中的应用经验有限。缺乏关于儿童致心律失常发生率的数据。
71例患有各种室上性和室性快速性心律失常的儿科患者（平均年龄7.3岁）接受了口服索他洛尔治疗。所有患者均入院开始索他洛尔治疗。在住院期间通过每日体表心电图（ECG）以及连续动态心电图监测评估索他洛尔的抗心律失常和致心律失常作用。
在41例室上性折返性心动过速患者中，38例（93%）患者使用索他洛尔后完全有效（41例中的27例[66%]）或部分有效（41例中的11例[27%]）。在主要为先天性心脏病术后发生心房扑动的患者中，索他洛尔在84%的患者中有效（19例中的9例完全有效，19例中的7例部分有效）。64%的儿童室性心动过速得到完全（11例中的3例）或部分（11例中的4例）控制。7例患者（10%）出现致心律失常作用，分别包括2例儿童因窦房阻滞和高度房室（AV）阻滞导致的症状性心动过缓；1例无症状高度AV阻滞；1例尖端扭转型室速；3例相关的室性异位活动增加。4例患者因致心律失常作用需要停药。所有患者的平均治疗持续时间为18个月（范围1至40个月）。
索他洛尔是一种对多种儿科快速性心律失常有效的抗心律失常药物。相当数量的患者出现致心律失常作用表明需要住院开始治疗并通过连续动态心电图进行密切监测。
