Pediatric Cardiology and Cardiac Surgery
Vol.25 No.5 2009 (681-686)
Chiho Tokunaga,1) Yuji Hiramatsu,1) Masakazu Abe,3) Shinya Kanemoto,1) Miho Takahashai-Igari,2) Hitoshi Horigome,2) and Yuzuru Sakakibara1)
Departments of 1)Cardiovascular Surgery and 2)Pediatrics, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, and 3)Department of Cardiovascular Surgery, Ibaraki Children’s Hospital, Ibaraki, Japan
Tachyarrhythmia after pediatric cardiac surgery often leads to hemodynamic instability and requires prompt management. We report four pediatric cases of various tachyarrhythmia successfully treated with an ultra-short-acting β-blocker; landiolol hydrochloride after open-heart surgery. Case 1: A 9-year-old girl had been diagnosed as having asplenia and pulmonary atresia. Paroxysmal atrial fibrillation occurred immediately after she underwent total cavopulmonary shunt and was successfully controlled by 40 μg/kg/min of landiolol. Case 2: A 10-day-old boy was diagnosed as having d-transposition of the great arteries. After the arterial switch operation, junctional ectopic tachycardia developed. Administration of 40 μg/kg/min of landiolol decreased his heart rate and resumed sinus rhythm within several hours, although epicardial pacing was required at 48 hours after the administration due to bradycardia. Case 3: A 6-year-old boy had been treated for hypertrophic obstructive cardiomyopathy. He developed complete A-V block after septal myectomy, and DDD pacemaker implantation was required. Since his atrial rate was too fast for adequate DDD pacing, 8 μg/kg/min of landiolol was initiated to modulate the atrial rate. After landiolol decreased his atrial rate, DDD pacing was successfully introduced. Case 4 : A 4-day-old boy underwent repair of infracardiac total anomalous of pulmonary venous connection. His postoperative course was complicated by rapid atrial flutter that impaired cardiac output. After 3 μg/kg/min of landiolol was administered, his heart rate was decreased and stabilized. Landiolol was efficacious in treating various tachyarrhythmias after pediatric cardiac surgery, specifically showing negative chronotropic effects without significant hemodynamic detriment. However, since neither the indication nor protocol in pediatric patients has been well established, secure monitoring and backup pacing is essential.