Procainamide for rate control of postsurgical junctional tachycardia

This study was conducted to determine the efficacy of procainamide therapy for rapid rate control of postoperative junctional tachycardia (JT). Postoperative JT is one of the most difficult forms of tachycardia to manage. Reported success with a variety of treatments of JT in infants and children ha...

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Bibliographic Details
Published in:Pediatric cardiology 2000-03, Vol.21 (2), p.123-128
Main Authors: Mandapati, R, Byrum, C J, Kavey, R E, Smith, F C, Kveselis, D A, Hannan, W P, Brandt, 3rd, B, Gaum, W E
Format: Article
Language:English
Subjects:
Analysis of Variance
Anti-Arrhythmia Agents - administration & dosage
Anti-Arrhythmia Agents - therapeutic use
Dose-Response Relationship, Drug
Female
Heart Defects, Congenital - surgery
Heart Rate - drug effects
Humans
Infant
Infant, Newborn
Male
Postoperative Complications - drug therapy
Procainamide - administration & dosage
Procainamide - therapeutic use
Tachycardia, Ectopic Junctional - drug therapy
Tachycardia, Ectopic Junctional - etiology
Treatment Outcome
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Summary:This study was conducted to determine the efficacy of procainamide therapy for rapid rate control of postoperative junctional tachycardia (JT). Postoperative JT is one of the most difficult forms of tachycardia to manage. Reported success with a variety of treatments of JT in infants and children has been inconsistent and limited. Rate control using procainamide was achieved in 17 children having rapid JT (heart rate >200 beats/min) between 1986 and 1997. In the first 5 patients (protocol A), following a loading dose of 3 mg/kg over 20 minutes, a continuous procainamide infusion was initiated at a rate of 20 microg/kg/min. The infusion dose was increased in 10 microg/kg steps every 30 minutes to 40-120 microg/kg/min until the heart rate decreased below the target rate of 180 beats/min. In the other 12 patients (protocol B), after a higher loading dose of 10 mg/kg the infusion rate was increased every 10-15 minutes until the heart rate decreased below the target rate of 180 beats/min. Procainamide decreased JT rates in all patients but the response was significantly faster in protocol B. In the patients treated with protocol A, pretreatment JT rates ranged from 203 to 240 (213+/-17) beats/min and decreased to 195+/-10 beats/min at 2 hours (p = ns), 186+/-8.8 at 4 hours (p
ISSN:0172-0643
1432-1971
DOI:10.1007/s002469910018