Ümit ŞEN, Aygün DİNDAR, Tijen DİRİ, Eker Rukiye ÖMEROĞLU, Türkan ERTUĞRUL

Çocukluk çağı ventriküler distritmisi tedavisinde propafenonun etkinliği ve güvenilirliği

Amaç: İ. Ü. İstanbul Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Çocuk Kardiyolojisi Polikliniği'ne başvuran, kronik ventrildiler disritmili hastalarda, propafenonım etkinliğini ve güvenilirliğinin belirlenmesi hedeflendi. Gereç ve Yöntem: Yaş ortalaması 10.9$pm$3.6 yıl olan 22 hastanın, fizik muayeneleri ve laboratuar tetkikleri yapıldı. Ventriküler erken vuru sıklığı, 24 saatlik Halter monitorizasyonu ile saptandı. Yüzeyel elektrokardiyografi (EKG) ile ventriküler disritmi tanısı alan ve 24 saatlik Halter monitorizasyonda, Lown sınıflamasına göre evre III ve üzerindeki asemptomatik hastalar ile evre II ve üzerinde semptomatik olan 4 ile 16 yaş arası hastalar çalışmaya alındı. Hastalara ortalama l0.7±1l mg/kg/gün dozunda propafenon tedavisi haşlandı. Tedaviye yanıt veren 15 vaka l yıl boyunca izlendi. İlaca başlandıktan sonraki ilk hafta ve daha sonraki 1., 3., 6. ve 12. aylarda kontrol muayeneleri yapıldı. Her kontrolde fizik muayene, ekokardiyografi ve Hotter monitorizasyonu tekrarlandı. Kan sayımı ve biyokimyasal, tetkikler ise, tedavi öncesi, 6. ve 12. aylarda yapıldı. Bulgular: Tüm bu parametrelerin istatistiksel değerlendirilmesi sonucunda, günlük ventriküler erken vuru sayısı ve maksimum kalp hızlarında anlamlı bir azalma saptandı. Bir yıllık izleme sonunda, ventriküler erken vuru sayısı 4253$pm$1885'den 651±232'ye (p

Anahtar Kelimeler:

Çocuk, Propafenon, Aritmi, Elektrokardiyografi, ayakta, Taşikardi

Efficacy and safety of oral propafenone in children with ventricular dysrhythmias

Aim: The aim of this study was to determine the effectiveness and safety of propafenone in children, referred to the pediatric cardiology outpatient clinic of Istanbul Medical Faculty. Materials and Methods: Twenty-two patients with an average age of 10.9$pm$3.6 years were investigated. Ventricular premature beat frequency has been determined by 24-hour Hotter monitorization in patients who were physically and biochemically checked. Patients between 4 and 16 years of age with ventricular dysrhythmia on electrocardiography (ECG), who had symptoms at stage II or no symptoms at stage III or higher stages according to Lown classification, were included in the study. Propafenone treatment with a mean dose of 10.7±1.1 mg/kg/day was given to patients. Fifteen of the patients who responded to the treatment were followed for I year. Controls were performed at the first week and 1st, 3rd, 6th, 12th months during the follow-up. Each evaluation included physical examination, 12-lead ECG, 24-hour Holier monitoring and echocardiography. Complete blood count and biochemical analysis were performed before treatment, at 6th and 12th monthly controls. Results: When all the parameters were statistically evaluated, it was determined that the daily number of ventricular premature beats and maximum heart rate decreased significantly. At the end of one year follow up, number of ventricular premature heats were decreased from 4253 ±1885 to 651 ±232 (p< 0.001) and the maximum heart rate decreased from 128$pm$17 to 112±9 (p<0.05) .Ventricular premature beat frequency decreased more than 80 % in half of the cases. The treatment was completely succesful in 50 % of the patients while 18.2 % of patients partially responded. With propafenone treatment, ventricular tachycardia attacks disappeared in three out of 8 cases, but other 5 cases with sustained VT had no response. Side effects were observed in six patients; lack of appetite in three patients, nausea in one patient, slight depression of left ventricular systolic function in one patient and presyncope in one patient. Conclusion: We may conclude that propafenone is effective and safe in the treatment of ventricular dysrhythmias in children.

Keywords:

Child, Propafenone, Arrhythmia, Electrocardiography, Ambulatory, Tachycardia,

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1. Vetter VL. What every pediatrician needs to know about arrhythmias in children who have had cardiac surgery. Pediatr Ann 1991; 20: 378-85.
2. Özer S, Özbarlas N, Özme Ş, et al. Tüm düzeltme ameliyatı uygulanmış olan Fallot tetralojili hastaların ventriküler disritmi yönünden değerlendirilmesi: 24 saatlik Holter monitorizasyon sonuçları ve hemodinamik bulgular. Turk J Cardiol 1993; 6: 227-31.
3. Bilge I. Çocuklarda disritmilerin Holter monitorizasyon yöntemi ile incelenmesi (uzmanlık tezi). İstanbul, 1992.
4. Jacobsen JR, Garson A, Gillette PC, Me Namara DG. Premature ventricular contractions in normal children. J Pediatr 1978; 92:36-8. 5. Lang D, Kupfer Schmid C, Bernuth GV. Langzeitbeoboctung bei herzgesunden Kindern mit ventrikulaerer Extrasystolie. Dtsch Med Wschr 1986; 111:7-10.
6. Scott O, Wiliams GJ, Fiddler GI. Results of 24 hour ambulatory monitoring of electrocardiogram in 131 healthy boys aged 10-13 years, Br Heart J, 198O; 44: 304-3.
7. Brentano CF, Kroemer HK, Lee JT, et âl. Propafenon. N Engl J Med 1990; 322: 518-25.
8. Nattel S. Antiarrhythmic drug classifications. Drugs 1991; 41:672-701:
9. Barbey JT. Clinical pharmacology and B- blocking efficacy of propafenorie. J Cardiovasc Pharma 1991; 17: 41-3.
10. Lombardi F; Torzillo D, Sandrone G, et al. Autonomic effects of antiarrhythmic drugs arid their importance. Eur Heart J 1992; 13: 38-43.
11. Coumel P, Leclercq JF, Assayâg P. European experience with the antiarrhythmic efficacy of propafenone for supraventricular and ventricular arrhythmias. Am J Cardiol 1984; 54: 60-6.
12. Cueni L, Podrid PJ. Propafenone therapy in patients with serious ventricular arrhythmia - noninvasive evaluation of efficacy. J Electrophysiol 1987; 1: 548-60.
13. Koike K, Hesslein PS, Finlay CD, et al. Atrial automatic tachycardia in children, Am J Cardiol 1988; 61: 1127-30.
14. Sariano J, Almendral J, Arenal A, et al. Rate dependent failure of ventricular capture in patients treated with oral propafenone. Eur Heart j 1992;13: 269-74.
15. Clark PI, Glasser SP, Spoto E. Arrhythmias detected by ambulatory monitoring, Chest 1980; 77: 722-5.
16. Walsh EP, Saul JP, Cardiac arrhythmias. In: Fyler DC (ed). Nadas Pediatric Cardiology, Philadelphia; Hanley and Belfus INC, 1992:377-434. 17. Garson A. Ventricular arrhythmias, In: Ollette PC, Garson A (eds). Pediatric arrhythmias. Eleetrophyslology and Pacing. Philadelphia; WB Satlhders Company, 1990: 427-500,
18. Anderson KP, De Camilla J, Moss AJ. Clinical significance of ventricular tachycardia (3 beats or longer) detected during ambulatory monitoring after myoeardial infarction. Circulation 1978; 57: 890-7.
19. Musto B, D'Onofrio A, Cavallaro C, et al Electrophysilogical effects and clinical efficacy of propafenone in children with recurrent paroxysmal supraventricular tachycardia. Circulation 1988; 78: 863-9.
20. Janousek J, Paul T, Reimcr A, et al. Usefulness of propafenone for supraventricular arrhythmias in infants and children. Am J Cardiol 1993; 72: 294-300.
21. Guccione P, Drago F, Di Donato RM, et al. Oral propafenone therapy for children with arrhythmias: Efficacy and adverse effects in midterm follow up. Am Heart J 1991; 122: 1022-7.
22. Weber H, Eigster G, Wesselhoeft H. Experience with propafenone in the treatment of arrhythmias in pediatric patients. Cardiac arrhythmias diagnosis, prognosis, therapy. Proceedings 1'st international rhytmoriorm congress 185-190.
23. Vignati G, Mauri L, Figini A. The use of propafenone in the treatment of tachyarrhythmias in children. Eur Heart J 1993; 14: 546-50.
24. Reimer A, Paul T, Kallfelz HC. Efficacy and safety of intravenous and oral propafenone in pediatric cardiac dysrhythmias. Am J Cardiol 1991; 68: 741-4.
25. Çeliker A, Özer S, Özme Ş, et al. Experience with propafenone for treatment of cardiac arrhythmias in children. Turkish J Pediatr 1990; 32: 85-92.
26. Ravid S, Podrid PJ, Novrit B. Safety of long term propafenone therapy for cardiac arrhythmia - experience with 774 patients. J Electrophysiol 1987; 1: 580-90.
27. Smith NA, Kates RE, Harrison DC. The clinical pharmacology of propafenone. J Electrophysiol 1987; 1: 517-26.
28. Hessling G, Brockmeier K, Rucdiger HS, Ulmer HE. Electrophysiologic effects and efficacy of intravenous propafenone in terminating atrioventricular reentrant tachycardia in children. Am J Cardiol 2001; 87: 802-4.
29. Moak JP, Smith RT, Garson A. Newer antiarrhythmic drugs inchidren. Am HJ 1987; 113: 179-85.
30. Gertie C, Beaufort-Krol, Th.E Margreet, et al. Oral propafenone as treatment for incessant supraventricular and ventricular tachycardia in children. Am J Cardiol 1992; 72:1213-4.
31. Janousek J, Paul T. Safety of oral propafenone in the treatment of arrhythmias in infants and children (European retrospective multicenter study) Working Group on Pediatric Arrhythmias and Electrophysiology of the Association of European Pediatric Cardiologist. Am J Cardiol 1998; 81:1121 -4.
32. Shen EN. Propafenone: A promising new antiarrhythmic agent Chest 1990; 98: 434-41.
33. Baker BJ, Brodsky MA, Dinh HA, et al. Hemodynamie effect of propafenone and the experience in patients with congestive heart failure. J Electrophysiol 1987; 1: 527-35.
34. Olm M, Munne P, Jimenez MJ. Severe reactive airways disease induced by propafenone. Chest 1989; 95: 1366-7,
35. Ito Shinya, Gow Robert, Verjee Zul, et al. Intravenous and oral propafenone for treatment of tachycardia in infants and children; Pharmocokinetics and clinical response. J Clin Pharmacol 1998; 38:496-501. 36. Steuver G, Weber H, Schmidinger H, et al. Plasma propafenone concentration in the evaluation of antiurrhylhmic efficacy. Eur Heart J 1991; 12:526-32.