Abstract
Aim. To evaluate the efficacy and safety of propafenone therapy in newborns and young children, including children with congenital heart defects (CHD). Material and methods . The study included 65 children with initiation of propafenone therapy at the age of 0-5 years. For diagnosis of arrhythmias and treatment control, electrocardiography (ECG), 24-hour Holter monitoring and echocardiography were performed. The initial dose of propafenone was 5-7 mg/kg/ day; the maximum dose — 15 mg/kg/day. The dose was titrated to effective with clinical and ECG control. It was considered acceptable to increase the duration of PQ interval and QRS complex by no more than 25% of the baseline value. The adverse and arrhythmogenic effects of the drug were evaluated. Results. Indications for propafenone administration were atrial tachycardia in 29 (44,61%) children, frequent premature ventricular contractions and ventricular tachycardia in 13 (20%) children, Wolff-Parkinson-White syndrome in 13 (20%) children, and other types of supraventricular tachycardia in 10 (15,39%) children. Sixteen (24,62%) children had CHD. In 20 (30,77%) children, propafenone was administrated in the neonatal period. The duration of propafenone therapy was 17,3±15,16 months. The drug was effective in 39 (60%) children (81,25% with CHD and 53,06% without CHD), not effective enough in 14 (21,54%) children, ineffective in 12 (18,46%) children. There was no association of the effectiveness/inefficiency of propafenone depending on the age, sex and the type of arrhythmia. Five (7,69%) children had prolongation of PQ interval and/or QRS by more than 25%. Arrhythmogenic effect of propafenone was observed in 1 (1,54%) child, noncardiac adverse effects — in 3 (4,62%) children. There were no cases of sudden cardiac death. Conclusion. Propafenone is an effective antiarrhythmic drug in newborns and young children with supraventricular and ventricular arrhythmias, including children with CHD. Using propafenone may be accompanied with adverse and arrhythmogenic effects, which were observed in 6% of children and were not associated with CHD.
Highlights
ААТ — антиаритмическая терапия, АВ — атриовентрикулярный, врожденными пороками сердца (ВПС) — врожденные пороки сердца, вне‐ запной сердечной смерти (ВСС) — внезапная сердечная смерть, д. ж. — дней жизни, ЖТ — желудочковая тахикардия, ЖЭС — желудочковая экстрасистолия, нарушений ритма сердца (НРС) — нарушения ритма сердца, WPW — Вольфа-Паркинсона-Уайта, ПАВУРТ — пароксизмальная АВ-узловая реципрокная тахикардия, ПБЛНПГ — полная блокада левой ножки пучка Гиса, ПБПНПГ — полная блокада правой ножки пучка Гиса, суправентрикулярных тахикардий (СВТ) — суправентрикулярная тахикардия, ЭКГ — электрокардиография
It was considered acceptable to increase the duration of PQ interval and QRS complex by no more than 25% of the baseline value
Five (7,69%) children had prolongation of PQ interval and/or QRS by more than 25%
Summary
Препара‐ тами выбора у детей с синдромом WPW и другими видами пароксизмальных суправентрикулярных тахикардий (СВТ), являются антиаритмические пре‐ параты I C класса: флекаинид, пропафенон (показа‐ ния I класса, уровень доказательности С) [2]. Показатель Мальчики ВПС НРС: Синдром WPW ПАВУРТ Предсердные тахикардии СВТ ЖЭС, ЖТ Возраст назначения пропафенона: 0-28 д. При увеличении длительности данных интервалов более чем на 25% доза пропафенона уменьшалась в 2 раза или препарат отменялся. Среди 12 детей с отсутствием положительного эффекта от приема пропафенона у 8 детей данный препарат был первым из ААП, у 2 детей имелся ВПС, у 5 детей имелись предсердные тахикар‐ дии, у 3 — синдром WPW, у 1 — ПАВУРТ, у 3 — желу‐ дочковые НРС
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