O'Sullivan J J, Gardiner H M, Wren C
Department of Paediatric Cardiology, Freeman Hospital, Newcastle upon Tyne, England, United Kingdom.
J Am Coll Cardiol. 1995 Oct;26(4):991-4. doi: 10.1016/0735-1097(95)00291-9.
This study compared the safety and efficacy of digoxin and flecainide in the prophylaxis of supraventricular tachycardia in infants.
Recurrence of supraventricular tachycardia in infants is common. Digoxin is the conventional drug of first choice for prophylaxis, but its efficacy has not been tested in a controlled clinical trial, and there is no consensus on the drug of choice when digoxin is ineffective.
We reviewed retrospectively the records of all infants with supraventricular tachycardia due to atrioventricular (AV) reentry admitted to our hospital between January 1986 and December 1993.
Thirty-nine infants presented with sustained AV reentrant tachycardia at age 1 to 330 days (median 12). Intravenous flecainide was required to maintain immediate control in six patients who were then treated with oral flecainide. The other 33 patients were treated with oral digoxin. There was no recurrence of tachycardia in 14 (42%) of the 33 patients (95% confidence interval [CI] 25% to 61%). In the other 19 patients (58%) (95% CI 39% to 75%), digoxin was replaced by oral flecainide because of multiple recurrence of tachycardia. Full control was achieved in all 19 of these patients (100%) (95% CI 82% to 100%) and in 5 of the 6 patients treated with both intravenous and oral flecainide. Thus, overall, flecainide was effective in 24 (96%) of 25 patients (95% CI 80% to 100%).
Comparison with previous natural history studies suggests that digoxin is ineffective in the prophylaxis of supraventricular tachycardia. Oral flecainide was effective in a small number of infants, with no adverse effects (95% CI 0% to 12%), and may now be preferred as the primary prophylactic agent.
本研究比较了地高辛和氟卡尼预防婴儿室上性心动过速的安全性和有效性。
婴儿室上性心动过速复发很常见。地高辛是预防的传统首选药物，但其疗效尚未在对照临床试验中得到检验，当地高辛无效时，对于首选药物也没有共识。
我们回顾性分析了1986年1月至1993年12月期间我院收治的所有因房室（AV）折返导致室上性心动过速的婴儿的病历。
39例婴儿在1至330天（中位数12天）时出现持续性房室折返性心动过速。6例患者需要静脉注射氟卡尼以立即控制心律，随后接受口服氟卡尼治疗。其余33例患者接受口服地高辛治疗。33例患者中有14例（42%）（95%置信区间[CI]25%至61%）未出现心动过速复发。在另外19例患者（58%）（95%CI 39%至75%）中，由于心动过速多次复发，地高辛被口服氟卡尼替代。所有这19例患者（100%）（95%CI 82%至100%）以及6例接受静脉和口服氟卡尼治疗的患者中的5例均实现了完全控制。因此，总体而言，氟卡尼在25例患者中的24例（96%）有效（95%CI 80%至100%）。
与先前的自然病史研究相比，提示地高辛在预防室上性心动过速方面无效。口服氟卡尼对少数婴儿有效，且无不良反应（95%CI 0%至12%），现在可能更适合作为主要预防药物。
