태아수종 및 선천성 심장병에 동반된 난치성 상심실성 빈맥을 보이는 미숙아에서 Amiodarone및 Digoxin 병합 치료 1례
Combination Therapies of Amiodarone and Digoxin for Refractory Supraventricular Tachycardia Accompanied by Congenital Heart Diseases in a Preterm Infant with Hydrops Fetalis
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
태아 부정맥(fetal arrhythmia)은 비면역학적 이상으로 인한 태아수종 (hydrops fetalis)을 유발하는 대표적인 원인중의 하나로, 궁극적으로 태아의 사망에 이를 수 있다. 상심실성 빈맥(supraventricular tachycardia)은 대부분 1세이전에 자연 소실 되나, 일부에서 장기간 항부간정맥(antiarrhythmic drugs)치료를 필요로 한다. 상심실성 빈맥을포함한 대부분의 신생아 빈맥에서 아데노신(adenosine)은 첫 번째로 사용되는 약물이다. 아데노신으로 조절되지않는 상심실성 빈맥의 경우 디곡신(digoxin)을 사용하여 조절 한다. 디곡신에 반응 하지 않는 경우 제 1 c 군과 제3군 항부정맥제의 사용이 추천된다. 아미오다론 (amiodarone)은 난치성 혹은 생명을 위협하는 빈맥을 보이는 영아에서 좋은 치료 효과를 보이나, 일부에서는 디곡신과의 병합요법을 통해 더 높은 치료 성적을 보고 하였다. 본증례는 태아빈맥, 태아-수종 및 선천성 심장병이 동반된 재태연령 32주 미숙아로 출생한 환아에서, 출생 후 계속하여 상심실성 빈맥을 보여 아데노신을 투여 하였으나 조절되지 않아, amiodarone과 digoxin을 병합 투여하여 빈맥이 치료되어 보고하는 바이다.
Abstract
Fetal tachycardia is at risk for developing low cardiac output, non-immune hydrops fetalis and ultimately fetal death. Spontaneous resolution of supraventricular tachycardia (SVT) is common during the first year of age, but some infants need long-term antiarrhythmic therapy. In almost neonatal tachyarrhythmia including SVT, adenosine is the drug of the first choice. Digoxin is used to treat the SVT which is not controlled with adenosine. Class Ic and III antiarrhythmic drugs are additionally recommended for the disease unresponsive to digoxin. Intravenous amiodarone is highly effective and safe in an infant with refractory or life threatening tachycardia. Some cases have been reported that amiodarone combined with digoxin therapy is effective for treating tachycardia. We herein report a case of a preterm infant–born at 32 weeks of gestational age–with hydrops fetalis and life-threatening refractory SVT accompanied by multiple congenital heart diseases. SVT was initially not responsive to adenosine therapy, however, it was then successfully controlled with combination therapies of amiodarone and digoxin.
참고문헌 (17)
- Moodley S, "Postnatal outcome in patients with fetal tachycardia", Pediatr Cardiol, 34, pp.81~87 (2013)
- Moak JP, "Supraventricular tachycardia in the neonate and infant", Prog Pediatr Cardiol, 11, pp.25~38 (2000)
- Paul T, "Supraventricular tachycardia in infants, children and adolescents:diagnosis, and pharmacological and interventional therapy", Paediatr Drugs, 2, pp.171~181 (2000)
- Dilber E, "Intravenous amiodarone used alone or in combination with digoxin for life-threatening supraventricular tachyarrhythmia in neonates and small infants", Pediatr Emerg Care, 26, pp.82~84 (2010)
- Drago F, "Amiodarone used alone or in combination with propranolol:a very effective therapy for tachyarrhythmias in infants and children", Pediatr Cardiol, 19, pp.445~449 (1998)
- Etheridge SP, "Amiodarone is safe and highly effective therapy for supraventricular tachycardia in infants", Am Heart J, 141, pp.105~110 (2001)
- Burri S, "Efficacy and safety of intravenous amiodarone for incessant tachycardias in infants", Eur J Pediatr, 162, pp.880~884 (2003)
- Perry JC, "Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol", J Am Coll Cardiol, 27, pp.1246~1250 (1996)
- Figa FH, "Clinical efficacy and safety of intravenous amiodarone in infants and children", Am J Cardiol, 74, pp.573~577 (1994)
- Mason JW, "Amiodarone blocks inactivated cardiac sodium channels", Pflugers Arch, 396, pp.79~81 (1983)
- Connolly SJ, "Evidence-based analysis of amiodarone efficacy and safety", Circulation, 100, pp.2025~2034 (1999)
- Cimic A, "Amiodarone hepatotoxicity with absent phospholipidosis and steatosis: a case report and review of amiodarone toxicity in various organs", Case Rep Pathol (2013)
- Singh BN, "The effect of amiodarone, a new anti-anginal drug, on cardiac muscle", Br J Pharmacol, 39, pp.657~667 (1970)
- Van Cott TE, "Amiodaroneinduced pulmonary toxicity: case study with syndrome analysis", Heart Lung, 42, pp.262~266 (2013)
- Yagishita A, "Amiodarone-induced thyrotoxicosis late after amiodarone withdrawal", Circ J, 77, pp.2898~2903 (2013)
- Tripathi A, "Factors associated with the occurrence and treatment of supraventricular tachycardia in a pediatric congenital heart disease cohort", Pediatr Cardiol (2013)
- 조혜정, "Multifocal Atrial Tachycardia in a Newborn", Neonatal medicine, 16(2), pp.239~243 (2009), 대한신생아학회