Drago F, Mazza A, Guccione P, Mafrici A, Di Liso G, Ragonese P
Pediatric Cardiology Department, Bambino Gesù Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
Pediatr Cardiol. 1998 Nov-Dec;19(6):445-9. doi: 10.1007/s002469900353.
The aim of the study was to evaluate the efficacy of amiodarone used alone or in combination with propranolol in infants and children affected by life-threatening or drug-resistant tachyarrhythmias. The study included 27 children (median age 3 months), affected by life-threatening and/or drug-resistant supraventricular or ventricular tachyarrhythmias. The loading dose of amiodarone was 10-20 mg/kg/day and the maintenance dose ranged between 3 and 20 mg/kg/day. When amiodarone was ineffective, propranolol was added at a dosage of 2-4 mg/kg/day. The study population was divided into two groups: group A was composed of patients <1 year and group B of patients >1 year. The effectiveness of the therapy was assessed by clinical evaluation, Holter monitoring, exercise testing, and, in patients with reentry tachycardias, electrophysiological testing. Amiodarone used alone was effective or partially effective in 4/14 (28%) patients in group A and in 11/13 (85%) patients in group B (p < 0.006). Among amiodarone-resistant patients, the combined therapy with propranolol was effective in 8/10 patients in group A and 2/2 patients in group B. Therefore, amiodarone used alone or in combination with propranolol was effective in 25/27 (93%) patients. During the follow-up (20.5 +/- 13 months) there were no arrhythmic effects but side effects were noted in 5/27 (18.5%) patients. Amiodarone seems to be an effective drug in the control of the life-threatening and/or drug-resistant supraventricular and ventricular tachyarrhythmias in children. The addition of propranolol can significantly enhance the success rate of this class III drug, especially in the treatment of reentry tachycardias due to accessory pathways.
本研究的目的是评估胺碘酮单独使用或与普萘洛尔联合使用对患有危及生命或耐药性快速心律失常的婴幼儿和儿童的疗效。该研究纳入了27名儿童（中位年龄3个月），他们患有危及生命和/或耐药性室上性或室性快速心律失常。胺碘酮的负荷剂量为10 - 20 mg/kg/天，维持剂量为3 - 20 mg/kg/天。当胺碘酮无效时，添加普萘洛尔，剂量为2 - 4 mg/kg/天。研究人群分为两组：A组由年龄<1岁的患者组成，B组由年龄>1岁的患者组成。通过临床评估、动态心电图监测、运动试验以及对于折返性心动过速患者进行电生理检查来评估治疗效果。单独使用胺碘酮时，A组4/14（28%）的患者有效或部分有效，B组11/13（85%）的患者有效（p < 0.006）。在对胺碘酮耐药的患者中，A组8/10的患者和B组2/2的患者使用普萘洛尔联合治疗有效。因此，单独使用或联合使用普萘洛尔的胺碘酮对25/27（93%）的患者有效。在随访期间（20.5±13个月），未出现心律失常，但5/27（18.5%）的患者出现了副作用。胺碘酮似乎是控制儿童危及生命和/或耐药性室上性和室性快速心律失常的有效药物。添加普萘洛尔可显著提高这种III类药物的成功率，尤其是在治疗因旁路引起的折返性心动过速时。
