Safety and efficacy of flecainide in the treatment of symptomatic children with Wolff-Parkinson-White syndrome

Adverse Drug Reactions in Children with Congenital Heart Disease: A Scoping Review

BACKGROUND

Congenital heart disease (CHD) is one of the leading causes of death. Safe and timely medical interventions, especially in children, can prolong their survival. The drugs prescribed for children with CHD are mainly based on the outcomes of drug therapy in adults with cardiovascular diseases, and their adverse drug reactions (ADRs) might be different. Therefore, the aim of this study was to investigate ADRs in children with CHD.

METHODS

This was a scoping review conducted in 2023. PubMed, Web of Science, Scopus, the Cochrane Library, Ovid, ProQuest, and Google Scholar databases were searched. All studies that reported ADRs for children with CHD and were published in English by 1 November 2023 were included in this study. Finally, the results were reported using a content analysis method.

RESULTS

A total of 87 articles were included in the study. The results showed that symptoms/signs/clinical findings, and cardiovascular disorders were the most common ADRs reported in children with CHD. The results also showed that most of the ADRs were reported for prostaglandin E1, amiodarone, prostaglandin E2, dexmedetomidine, and captopril, respectively.

CONCLUSION

The review underscores the wide array of ADRs in children with CHD, particularly in antiarrhythmics, diuretics, beta-blockers, anticoagulants, and vasodilators, which affected cardiovascular, respiratory, endocrine, metabolic, genitourinary, gastrointestinal, and musculoskeletal systems. Tailored treatment is imperative, considering individual patient characteristics, especially in the vulnerable groups. Further research is essential for optimizing dosing, pharmacogenetics, and alternative therapies to enhance patient outcomes in CHD management.

Flecainide improves cardiac synchronization in an early infant with Wolff-Parkinson-White syndrome with left ventricular dyssynchrony

Recently, cases of pharmacological resynchronization for Wolff-Parkinson-White syndrome (WPWS) in children with left ventricular dyssynchrony (LVD) were reported, but an appropriate pharmacological therapy has not yet been established. A 3-month-old, previously healthy female patient was referred to our hospital due to supraventricular tachycardia (SVT). After resolution of the SVT, 12-lead electrocardiography (ECG) showed ventricular pre-excitation. Transthoracic echocardiography showed LVD with no findings of congenital heart disease or cardiomyopathy. To prevent SVT recurrence, oral propranolol administration was started, but the SVT recurred one month later. To prevent further recurrences, oral flecainide administration was started, as the patient's body weight was insufficient for catheter ablation to be performed safely. When the flecainide dosage was increased to 50 mg/m²/day, the pre-excitation resolved, and the LVD improved. Holter ECG showed that the resolution of pre-excitation depended on the serum concentration of flecainide. There are only few reports on pharmacological resynchronization in WPWS patients with LVD (LVD-WPWS). The present report is the first to examine the efficacy of flecainide in patients with recurrent SVT. Flecainide may be a safe and effective alternative resynchronization therapy for LVD-WPWS patients, especially for children in whom catheter ablation cannot be performed safely due to insufficient body weight. <Learning objective: While cases of pharmacological resynchronization for Wolff-Parkinson-White syndrome (WPWS) in children with left ventricular dyssynchrony (LVD) have been reported, an appropriate pharmacological therapy has yet to be established. Flecainide may be a safe and effective alternative resynchronization therapy for WPWS with LVD, especially for children in whom catheter ablation cannot be performed safely due to insufficient body weight.>.

Improvement in Dyssynchrony with Pharmacological Ablation of Right-Sided Accessory Pathway-Induced Cardiomyopathy in Infants

Right-sided accessary pathways in patients with Wolff-Parkinson-White (WPW) syndrome may cause cardiac dyssynchrony and dilated cardiomyopathy, with a characteristic septal shape, irrespective of any supraventricular tachycardia episodes. We report on two infants (13 and 5 months), whose right-sided accessary pathway-induced dilated cardiomyopathy was successfully treated by flecainide for the first time. After the flecainide administration, an abnormal aneurysmal dilation of the basal interventricular septum was almost restored to normal, and the decreased ejection fraction recovered. Flecainide use may be an important therapeutic option for this entity to avoid catheter ablation during infancy.

Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Antiarrhythmics

OBJECTIVE

Arrhythmias are a common occurrence in critically ill pediatric patients. Pharmacotherapy is a usual modality for treatment and prevention of arrhythmias in this patient population. This review will highlight particular arrhythmias in the pediatric critical care population and discuss salient points of pharmacotherapy of these arrhythmias. The mechanisms of action for the various agents, potential adverse events, place in therapy, and evidence for their use will be summarized.

DATA SOURCES

The literature was searched for articles related to the topic. Expertise of the authors and a consensus of the editors were additional sources of data in the article.

DATA SYNTHESIS

The author team synthesized the current pharmacology and recommendations and present them in this review. Tables were generated to summarize the state of the art evidence-based practice.

CONCLUSION

Specialized knowledge as to the safe and effective use of the antiarrhythmic pharmacotherapy in the intensive care setting can lead to safe and effective rhythm management in patients with complex heart disease.