Pfammatter J P, Bauersfeld U
Paediatric Cardiology, University Children's Hospital, Berne, Switzerland.
Drug Saf. 1998 May;18(5):345-56. doi: 10.2165/00002018-199818050-00004.
Paroxysmal supraventricular tachycardia caused by atrioventricular re-entry is the most frequent arrhythmia in children of all age groups. It represents the most frequent clinical situation where antiarrhythmic drug therapy has to be considered in a child. Acute termination of an episode of tachycardia in all paediatric age groups is nowadays best achieved with an intravenous bolus injection of adenosine. Since the introduction of adenosine into clinical practice, the need to proceed to electrocardioversion has been limited to the infant (or in rare cases an older child) with severe cardiovascular collapse. In the haemodynamically stable infant or child, several other antiarrhythmic agents such as flecainide or propafenone can be used with relative safety and with a high probability of immediate success. The same is true for verapamil, although intravenous administration should be avoided in the first year of life. In newborns and in infants with first presentation of an episode of tachycardia, drug prophylaxis of recurrences is usually recommended for the whole of the first year of life. Prophylactic treatment may consist of oral digoxin as first choice, with a beta-blocker as an alternative. In an infant with Wolff-Parkinson-White syndrome it may be wise to avoid digoxin and to start treatment with a beta-blocker. Antiarrhythmic class Ic drugs such as propafenone or flecainide, and the class III agent sotalol, are widely used as the next steps of therapy when digoxin and beta-blockers fail to prevent recurrences. These agents are about equivalent with regard to their efficacy and risk profile. Amiodarone is considered to be an agent that should be reserved for use in situations when the tachycardia is refractory to the previously named agents. Older children may commence treatment with a beta-blocker and the subsequent steps of treatment are the same as those for infants. Curative catheter ablation of accessory pathways has been shown to be as efficient and well tolerated in the paediatric age group as it is in adults. This treatment option is nowadays quite often offered to older children. However, in infants and smaller children, ablation is used as a last resort. Rare forms of paediatric supraventricular tachycardia (other than atrioventricular re-entry through the atrioventricular node or accessory pathways) are occasionally difficult to treat and present special problems. For each of these arrhythmias, a specially tailored individual therapeutic approach is needed.
房室折返性阵发性室上性心动过速是各年龄组儿童中最常见的心律失常。它是儿童中最常见的需要考虑抗心律失常药物治疗的临床情况。目前，在所有儿科年龄组中，静脉推注腺苷是终止心动过速发作的最佳方法。自从腺苷应用于临床实践以来，需要进行电复律的情况仅限于患有严重心血管功能衰竭的婴儿（或极少数大龄儿童）。对于血流动力学稳定的婴儿或儿童，可以相对安全地使用其他几种抗心律失常药物，如氟卡尼或普罗帕酮，且立即成功的可能性很大。维拉帕米也是如此，尽管在出生后第一年应避免静脉给药。对于首次出现心动过速发作的新生儿和婴儿，通常建议在出生后的第一年进行药物预防复发。预防性治疗首选口服地高辛，也可选用β受体阻滞剂。对于患有预激综合征的婴儿，避免使用地高辛而开始使用β受体阻滞剂治疗可能是明智的。当使用地高辛和β受体阻滞剂未能预防复发时，Ic类抗心律失常药物如普罗帕酮或氟卡尼以及III类药物索他洛尔被广泛用作下一步治疗药物。这些药物在疗效和风险方面大致相当。胺碘酮被认为是一种应保留用于心动过速对上述药物难治的情况的药物。大龄儿童可以开始使用β受体阻滞剂治疗，后续治疗步骤与婴儿相同。已证明，在儿科年龄组中，对旁道进行根治性导管消融与在成人中一样有效且耐受性良好。现在，这种治疗选择经常提供给大龄儿童。然而，在婴儿和较小儿童中，消融作为最后手段使用。儿科室上性心动过速的罕见形式（除通过房室结或旁道的房室折返外）有时难以治疗，并存在特殊问题。对于每种此类心律失常都需要一种专门定制的个体化治疗方法。
