Managing acute supraventricular tachycardia and the role of intravenous sotalol.

IF 2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Current Opinion in Cardiology Pub Date : 2025-07-01 Epub Date: 2025-04-09 DOI:10.1097/HCO.0000000000001223
Mitchell I Cohen, Robert Przybylski
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引用次数: 0

Abstract

Purpose of review: The initial approach to stable supraventricular tachycardia (SVT) in children is either adenosine or vagal maneuvers. While automatic tachycardias do not respond to such an approach, even reentrant arrythmias will fail to terminate with adenosine or vagal maneuvers. Little consensus exists on the ideal second line antiarrhythmic medication for stable SVT. This article reviews the current approach to stable SVT and early pediatric studies using intravenous (i.v.) sotalol.

Recent findings: The development of i.v. sotalol has spawned enthusiasm for a novel antiarrhythmic for refractory reentrant SVT and other automatic atrial tachycardias. Retrospective pediatric multicenter studies have shown an excellent conversion (50-90%) of refractory SVT with a single dose of i.v. sotalol; generally, over 30 min. Cautioned should be exercised using i.v. sotalol in patients with ventricular dysfunction and dose adjustments need to be made based on creatinine clearance. In addition, i.v. sotalol has shown promising early results in slowing the ventricular rate in postoperative junctional ectopic tachycardia faster than i.v. amiodarone.

Summary: Intravenous sotalol has shown promising results in refractory pediatric SVT. Protocol driven dosing with the help of hospital pharmacists should be established before i.v. sotalol is prescribed. Future prospective studies especially in postoperative patients, neonates and patients with congenital heart disease are needed.

急性室上性心动过速的治疗及静脉索他洛尔的作用。
回顾的目的:稳定的室性心动过速(SVT)在儿童的最初途径是腺苷或迷走神经操作。虽然自动心动过速对这种方法没有反应,但即使是再入性心律失常也不能通过腺苷或迷走神经操纵来终止。对于稳定室性心动过速的理想二线抗心律失常药物,目前尚未达成共识。这篇文章回顾了目前稳定SVT的方法和使用静脉注射(i.v.)索他洛尔的早期儿科研究。最近的发现:静脉注射索他洛尔的发展引发了人们对一种新型抗心律失常药物的热情,用于治疗难治性再入性室速和其他自动心房心动过速。回顾性儿科多中心研究表明,单剂量静脉注射索他洛尔对难治性SVT有很好的转换率(50-90%);一般超过30分钟。有心室功能障碍的患者应注意静脉注射索他洛尔,并根据肌酐清除率调整剂量。此外,静脉注射索他洛尔在降低术后结性异位心动过速的心室率方面已经显示出比静脉注射胺碘酮更快的早期效果。总结:静脉注射索他洛尔治疗难治性儿科上室血栓显示出良好的效果。在静脉注射索他洛尔之前,应在医院药剂师的帮助下制定方案驱动给药。未来的前瞻性研究,特别是在术后患者,新生儿和先天性心脏病患者需要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Current Opinion in Cardiology
Current Opinion in Cardiology 医学-心血管系统
CiteScore
4.20
自引率
4.30%
发文量
78
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Cardiology is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With fourteen disciplines published across the year – including arrhythmias, molecular genetics, HDL cholesterol and clinical trials – every issue also contains annotated reference detailing the merits of the most important papers.
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