I. Treatment of supraventricular premature contractions.
Treatment of premature supraventricular beats should first consider removing the primary cause and the trigger of premature beats. Asymptomatic premature supraventricular beats, including short paroxysmal atrial tachycardia, do not require treatment. Supraventricular premature beats with intolerable symptoms or causing paroxysmal supraventricular tachycardia should be considered for pharmacological treatment.
The ECG, Holter monitoring (24h ambulatory ECG monitoring), echocardiography, exercise test and chest X-ray are used in conjunction with clinical investigations to understand whether there is organic heart disease associated with premature beats, taking care not to base the diagnosis of organic heart disease (e.g. myocarditis) solely on premature beats. Special emphasis is placed on removing the causes of premature beats and treating the underlying heart disease. The aim of pharmacological treatment is to reduce the symptoms of premature ventricular contractions, improve the quality of life of the child, improve hemodynamic disturbances and prevent the risk of serious arrhythmias.
1. Indications for antiarrhythmic drugs in the treatment of premature ventricular contractions
Class I No drug therapy is required for
(1) Asymptomatic benign ventricular premature contractions (simple ventricular premature contractions), generally defined as those without organic heart disease and with monogenic, episodic ventricular premature contractions.
(2) Premature ventricular contractions due to left ventricular pseudotendinous.
Class IIA No pharmacological treatment is advocated: ventricular premature without organic heart disease and without hemodynamic alterations. However, drug therapy may be considered for those with unacceptable conscious symptoms or complex ventricular premature with a tendency to develop into serious arrhythmias.
Class IIB Medically treatable.
① Frequent or complex ventricular premature with no organic heart disease leading to hemodynamic alterations.
② Ventricular arrhythmias with prognostic significance.
① postoperative ventricular prematureness in congenital heart disease.
(ii) acute myocarditis with multiple types of premature beats.
③Ventricular premature after cardiopulmonary resuscitation or after resuscitation of sustained ventricular tachycardia.
④ congenital or acquired long QT syndrome with ventricular premature.
⑤ dilated or hypertrophic cardiomyopathy combined with premature ventricular contractions.
(6) Mitral valve prolapse combined with ventricular premature.
(7) Frequent and complicated ventricular premature due to digitalis.
Category III Must be treated.
Malignant ventricular arrhythmia: with organic heart disease, whose arrhythmia is persistent ventricular tachycardia (ventricular tachycardia duration >30s) or ventricular fibrillation.
(2) Drug selection.
Propafenone (cardioplegia), beta-blockers or mexilate may be considered for benign ventricular premature with unacceptable spontaneous symptoms or with a tendency to develop into severe arrhythmias. The purpose of the medication is to provide temporary relief of symptoms so that the patient can gradually adapt and tolerate the medication without the need for long-term use. Phenytoin sodium or mexilate may be used for frequent or complex ventricular premature events due to digitalis and for postoperative ventricular premature events after congenital heart disease. For other ventricular arrhythmias with prognostic significance, beta-blockers can be used, and amiodarone can be used with caution. Intravenous lidocaine or amiodarone is used for malignant ventricular arrhythmias. Clinical data suggest that the combined application of amiodarone and β-blockers may improve the efficacy and reduce the morbidity and mortality rate.
(3) Focus on follow-up.
Regular 24-h electrocardiogram and echocardiogram are used to monitor changes in disease.