The Initial Research Of The Clinical Intervention For The Children’s Premature Ventricular Contractions

Objective:To explore the clinical value of metoprolol and Propafenone in the intervention for children’s premature ventricular contractions(PVCs) by using the different effectiveness of the different type of PVCs to drugs.Methods:Collected a total of 141 of children who were diagnosed with PVCs in Children’s Hospital of Chongqing Medical University from Jan 2012 to Mar 2014. All cases were divided into three groups:metoprolol group (to receive metoprolol 1-2mg/(kg.d), twice daily for 2 weeks; followed by drug withdrawal if PVCs were significantly reduced or the therapy was considered to be invalidity; n=47), propafenone group (to receive propafenone 5mg/(kg.d), three times daily for 2 weeks; followed by drug withdrawal if PVCs were significantly reduced or the therapy was considered to be invalidity; n=46) and control group (without treatments of any antiarrhythmic drugs; n=48). Among them, all the patients were administered with conventional symptomatic therapy (such as coenzyme Q10、fructose diphosphate ect.). And 24h Holter monitorings were measured for at least every three months, the first of which was considered to be at entry of the study. The 24h Holter monitorings, recorded before and after therapy for each group, were analyzed with statistical methods.Results:1.Among the 141 patients of diagnosed PVCs, metoprolol group includes 47 patients(male 30,femalel7; myocarditis 8;left ventricular enlargement 1; Premature ventricular contraction induced cardiomyopathy 2),the age of patients with DCG for the first time ranged from 0.5-16.33 years old (mean 8.09±0.60 years old); propafenone group includes 46 patients(male 30,femalel6; myocarditis 13),the age of patients for the first time ranged from 0.08～ 17.67 years old (mean 6.19±0.61years old); control group includes 48 patients(male 29,femalel9; myocarditis 10), the age ranged from 0.17～15.00 years old (mean 6.39±0.60years old).2. The efficacy of metoprolol and propafenone, respectively compared with control group:In the metoprolol group, the effective rate is 63.8% (efficacy and inefficacy:30 vs.17); in the propafenone group, the effective rate is 73.1% (efficacy and inefficacy:35 vs.11); in the control group, the effective rate is 32.6% (efficacy and inefficacy:15 vs.33).The metoprolol and propafenone have certain and equivalent effect to treat PVCs in children.3. The duration for effective treatment in three groups:In the 2-week treatments, the effective rate in metoprolol group, propafenone group and control group is 6.4%(3/47), 58.7%(27/46) and 0%(0/48),respectively,and propafenone has a shorter onset time. In the 1-month treatments, the effective rate in metoprolol group, propafenone group and control group is 38.3% (18/47),65.2% (30/46) and 6.3% (3/48), respectively,the propafenone is quicker too.In the 3-month treatments, the effective rate in metoprolol group, propafenone group and control group is 53.2% (25/47),69.6% (32/46) and 14.6% (7/48), respectively,the metoprolol and propafenone have a similar onset time.4. the recurrence rate in metoprolol and propafenone group:The recurrence rate with discontinuation of metoprolol for 1 year is 2.2% (1/47). And the recurrence rate with discontinuation of propafenone for 1 month,3 months and 6 months is respectively? (1/47),?(2/47) and?(1/47).5.the severe adverse events:There’s no severe adverse events in metoprolol group. In the propafenone group, there’s 6 severe adverse events (12.5%). Among them, three patients had the side effect of digestive tract; one patients had the impaired liver function; and 2 patients had atrioventricular block (AVB).Conclusion:1. The efficacy of metoprolol and propafenone are statistically significance and the therapeutic effect of two drugs may be similar.2. The duration for effective treatment of propafenone may be shorter than that of metoprolol, and its long-term curative effect need to be confirmed futher.3. The recurrence rate of metoprolol is less than that of propafenone, which suggested that the long-term curative effect of metoprolol may be superior to that of propafenone.4. There’s no severe adverse events in metoprolol, which supported its safety. The severe adverse events in propafenone may include the atrioventricular block and exocardial side effects.