Luz Sandoval, Claudia Arenz, Michael Hamann, Sven Chlench
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引用次数: 0
Abstract
Objective: To evaluate whether landiolol combined with amiodarone improves heart rate and rhythm control compared to amiodarone alone in paediatric patients with postoperative junctional ectopic tachycardia after surgery for congenital heart defect.
Methods: We retrospectively identified 24 cases of junctional ectopic tachycardia among 962 children who underwent surgery for congenital heart defects at the German Paediatric Heart Centre between January 2022 and June 2024. Patients received either amiodarone monotherapy or a combination of landiolol and amiodarone. Time to heart rate control and rhythm normalisation, haemodynamic stability, and adverse events were assessed.
Results: Patients who received amiodarone and landiolol achieved faster heart rate control than patients who received amiodarone alone (median 6.7 vs. 14.7 h, p = 0.02, Cohen's d = 1.05; large effect). Among patients who received landiolol first, control was reached even earlier (2.4 vs. 8 h, p = 0.05, Cohen's d = 1.49; very large effect). A significant heart rate reduction occurred within 40-120 min after landiolol initiation (mean difference: -23.7 bpm, 95% CI: -45.4 to -1.9, p = 0.04, r = 0.45; medium effect), while no significant effect was observed in patients who received amiodarone alone. Haemodynamic parameters remained stable, although hypotension requiring discontinuation occurred in 11.1% of Landiolol-treated patients.
Conclusions: In this retrospective analysis, combined landiolol and amiodarone therapy demonstrated a shorter time to heart rate control compared to amiodarone alone, especially when landiolol was initiated first. These findings require confirmation in prospective studies.
目的：评价兰地洛尔联合胺碘酮与单用胺碘酮相比，是否能改善先天性心脏缺损术后结性异位心动过速患儿的心率和节律控制。方法：我们回顾性地从2022年1月至2024年6月在德国儿科心脏中心接受先天性心脏缺陷手术的962名儿童中发现24例结膜异位性心动过速。患者接受胺碘酮单药治疗或兰地洛尔和胺碘酮联合治疗。评估到心率控制和心律正常化的时间、血流动力学稳定性和不良事件。结果：胺碘酮联合兰地洛尔组患者心率控制速度快于单用胺碘酮组（中位数6.7 h vs 14.7 h, p = 0.02, Cohen’s d = 1.05，效应大）。在先服用兰地洛尔的患者中，达到控制的时间更早（2.4 h vs 8 h, p = 0.05, Cohen’s d = 1.49，效果非常大）。兰地洛尔开始治疗后40-120分钟内出现显著的心率降低（平均差值：-23.7 bpm, 95% CI: -45.4至-1.9,p = 0.04, r = 0.45；中效），而单独接受胺碘酮治疗的患者无显著效果。血液动力学参数保持稳定，尽管11.1%的接受兰地洛尔治疗的患者出现了需要停药的低血压。结论：在这项回顾性分析中，兰地洛尔和胺碘酮联合治疗比单独使用胺碘酮能更短的时间达到心率控制，特别是当兰地洛尔首先开始使用时。这些发现需要在前瞻性研究中得到证实。
期刊介绍：
Cardiology in the Young is devoted to cardiovascular issues affecting the young, and the older patient suffering the sequels of congenital heart disease, or other cardiac diseases acquired in childhood. The journal serves the interests of all professionals concerned with these topics. By design, the journal is international and multidisciplinary in its approach, and members of the editorial board take an active role in the its mission, helping to make it the essential journal in paediatric cardiology. All aspects of paediatric cardiology are covered within the journal. The content includes original articles, brief reports, editorials, reviews, and papers devoted to continuing professional development.
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