【体外膜肺ECMO精品课件】 The diagnosis and management of supraventricular tachycardia in infants.ppt

The diagnosis and management of supraventricular tachycardia in infantsPart II: Management options Leonard Steinberg, MD Timothy Knilans, MD The Heart Center Children’s Hospital Medical Center Cincinnati, OH Overview Commonly available pharmacotherapies Acute management Subacute management Chronic management Radiofrequency ablation Therapy: commonly used drugs Class I: sodium channel blockers procainamide flecainide Class II: ?-blockers propranolol esmolol Class III amiodarone sotalol Class IV: Ca channel blockers verapamil Miscellaneous digoxin adenosine Drugs: class IA (procainamide) Action: slows conduction and prolongs refractoriness in muscle, specialized conduction tissue, and accessory pathways Indications atrial re-entry: atrial fibrillation, atrial flutter accessory pathway tachycardia, particularly if short RP Considerations rapid metabolism frequent dosing serum concentrations and ECG’s faster ventricular rates negative inotropy Drugs: class IC (flecainide) Action slows conduction in muscle, conduction tissue, and AP’s suppresses automaticity Indications primary atrial tachycardias (reentrant and automatic) accessory pathway tachycardia, particularly if short RP Considerations negative inotropy faster ventricular rates proarrhythmia serum concentrations and ECG’s ensure proper dosing avoid in structural heart defects Drugs: class II (propranolol) Action suppresses automaticity (and ectopy) slows AV node conduction and prolongs refractoriness Indications automatic atrial tachycardia all reentrant tachycardias (reduces inciting events) Considerations QID dosing negative inotropy systemic effects Drugs: class II (esmolol) Action suppresses automaticity (and ectopy) slows AV node conduction and prolongs refractoriness Indications automatic atrial tachycardia all reentrant tachycardias (reduces inciting events) Considerations very short half life negative inotropy systemic effects Drugs: class III (amiodarone) Action slows conduction and pr