Dodo H, Gow R M, Hamilton R M, Freedom R M
Division of Cardiology, Hospital for Sick Children, Toronto, Ontario, Canada.
Am Heart J. 1995 May;129(5):990-5. doi: 10.1016/0002-8703(95)90121-3.
Chaotic atrial rhythm (CAR) usually occurs as a sequela of chronic obstructive lung disease in adults. We report the clinical manifestations and response to therapy in nine children with CAR treated predominantly with propafenone or amiodarone. Age at presentation ranged from 1 day to 30 months; six patients were < or = 2 weeks old. Six patients had tachycardia, and three had congestive heart failure. The atrial rate was 200 to 500 (mean 369 +/- 71) beats/min and the ventricular rate 150 to 300 (mean 251 +/- 37) beats/min. Eight patients had cardiac abnormalities. Intravenous drug therapy was not successful in converting CAR to sinus rhythm in any patient. A mean of four (range three to five) drugs was used in each patient; amiodarone and propafenone, alone or in combination, proved most successful. Seven patients were discharged from the hospital: full control was achieved in three (digoxin and amiodarone in two and digoxin, amiodarone, and procainamide in one), good control in three (digoxin, amiodarone, and propafenone in two and digoxin and propafenone in one), and ventricular rate control in one (digoxin, amiodarone, and propafenone). Two neonates with hypertrophic cardiomyopathy died. Long-term follow-up showed that CAR had resolved in five patients but persisted in two. We conclude that CAR remains difficult to control despite the use of newer antiarrhythmic agents but may resolve during long-term follow-up.
紊乱性房性心律（CAR）通常是成人慢性阻塞性肺疾病的后遗症。我们报告了9例主要用普罗帕酮或胺碘酮治疗的CAR患儿的临床表现及治疗反应。就诊时年龄从1天至30个月；6例患者年龄≤2周。6例有心动过速，3例有充血性心力衰竭。房率为200至500（平均369±71）次/分，室率为150至300（平均251±37）次/分。8例有心脏异常。静脉用药未能使任何患者的CAR转为窦性心律。每名患者平均使用4种（范围3至5种）药物；单独或联合使用胺碘酮和普罗帕酮最为成功。7例患者出院：3例完全控制（2例用地高辛和胺碘酮，1例用地高辛、胺碘酮和普鲁卡因胺），3例良好控制（2例用地高辛、胺碘酮和普罗帕酮，1例用地高辛和普罗帕酮），1例心室率得到控制（用地高辛、胺碘酮和普罗帕酮）。2例肥厚型心肌病新生儿死亡。长期随访显示，5例患者的CAR已消失，但2例仍持续存在。我们得出结论，尽管使用了新型抗心律失常药物，但CAR仍难以控制，但在长期随访中可能会消失。
