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Toni E, Ayatollahi H, Abbaszadeh R, Fotuhi Siahpirani A. Adverse Drug Reactions in Children with Congenital Heart Disease: A Scoping Review. Paediatr Drugs 2024:10.1007/s40272-024-00644-8. [PMID: 39044096 DOI: 10.1007/s40272-024-00644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2024] [Indexed: 07/25/2024]
Abstract
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.
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Affiliation(s)
- Esmaeel Toni
- Medical Informatics, Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Medical Informatics, Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Reza Abbaszadeh
- Pediatric Cardiology, Heart Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Fotuhi Siahpirani
- Department of Bioinformatics, Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
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Ciriello GD, Sorice D, Orlando A, Papaccioli G, Colonna D, Correra A, Romeo E, Esposito R, De Marco M, Diana V, Giordano M, Barrile LS, Russo MG, Sarubbi B. Antiarrhythmic therapy for narrow QRS supraventricular tachyarrhythmias in newborns and infants in the first year of life: Potent tools to be handled with care. Indian Pacing Electrophysiol J 2024:S0972-6292(24)00109-8. [PMID: 39033975 DOI: 10.1016/j.ipej.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/02/2024] [Accepted: 07/19/2024] [Indexed: 07/23/2024] Open
Abstract
Supraventricular tachyarrhythmias pose a significant challenge in neonates and infants, particularly within the first year of life, where prompt and effective management is crucial. By synthesizing available evidence and clinical experience, this review aims to provide a comprehensive overview of antiarrhythmic therapy in this vulnerable population, with a focus on narrow QRS supraventricular tachyarrhythmias. This review examines the current understanding of supraventricular tachyarrhythmia management and discusses the challenges associated with antiarrhythmic therapy in newborns and infants during the critical first year of life, evaluating the efficacy and safety of various antiarrhythmic agents commonly utilized in this population, including dosing considerations, adverse effects, and strategies for acute management and prophylactic long-term antiarrhythmic treatment.
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Affiliation(s)
- Giovanni Domenico Ciriello
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy.
| | - Davide Sorice
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Antonio Orlando
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Giovanni Papaccioli
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Diego Colonna
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
| | - Raffaella Esposito
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | - Marina De Marco
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | - Veronica Diana
- Appropriateness of Care Unit, Monaldi Hospital, Naples, Italy
| | - Mario Giordano
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | | | - Maria Giovanna Russo
- Pediatric Cardiology Unit, "L.Vanvitelli" University, Monaldi Hospital, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease and Congenital and Familial Arrhythmias Unit - Monaldi Hospital - Naples, Italy
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Wright KN, Nguyenba T, Irvin HM. Lidocaine for chemical cardioversion of orthodromic atrioventricular reciprocating tachycardia in dogs. J Vet Intern Med 2019; 33:1585-1592. [PMID: 31222803 PMCID: PMC6639483 DOI: 10.1111/jvim.15546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/28/2019] [Indexed: 11/27/2022] Open
Abstract
Background Typical atrioventricular accessory pathways (APs) are composed of myocardial cells. They provide electrical connections between atria and ventricles separate from the normal conduction system. Accessory pathways can participate in a macroreentrant circuit resulting in orthodromic atrioventricular reciprocating tachycardia (OAVRT). Hypothesis Because of ultrastructural similarities of typical AP cells to ventricular myocardial cells, we hypothesized lidocaine would be effective in blocking AP conduction, thus terminating OAVRT. Animals Thirty‐two consecutive client‐owned dogs presenting with narrow complex tachyarrhythmias were confirmed to have OAVRT by electrophysiologic study (EPS). Methods Prospective, nonrandomized, single‐arm study with lidocaine administered IV to dogs during OAVRT in 2 mg/kg boluses to a cumulative dose of 8 mg/kg or development of adverse effects. Electrocardiograms were monitored continuously. Subsequent EPS was performed to confirm OAVRT and the absence of other tachycardia mechanisms. Results Twenty‐seven dogs experienced OAVRT cardioversion with lidocaine, before or at the time of adverse effects. Orthodromic atrioventricular reciprocating tachycardia in 5 dogs did not cardiovert before adverse effects, precluding additional dosing. Median total lidocaine dose for cardioversion was 2 mg/kg (interquartile range, 2‐5.5 mg/kg). Dogs with right free wall APs had a significantly higher rate of cardioversion than did dogs with right posteroseptal APs. Conclusions and Clinical Importance Lidocaine successfully cardioverted OAVRT in 84.4% of dogs in our study before adverse effects precluded additional dosing. In 5 dogs with dose limited by adverse effects, it is unknown whether cardioversion would have occurred at a higher cumulative dose.
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Affiliation(s)
- Kathy N Wright
- Department of Cardiology, MedVet Medical and Cancer Centers for Pets, Cincinnati, Ohio
| | - Thaibinh Nguyenba
- Department of Cardiology, MedVet Medical and Cancer Centers for Pets, Worthington, Ohio
| | - Holly M Irvin
- Department of Cardiology, MedVet Medical and Cancer Centers for Pets, Cincinnati, Ohio
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Stasiak A, Niewiadomska-Jarosik K, Kędziora P. Clinical course and treatment of children and adolescents with the preexcitation syndrome - own studies. DEVELOPMENTAL PERIOD MEDICINE 2018. [PMID: 30056397 PMCID: PMC8522904 DOI: 10.34763/devperiodmed.20182202.113122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Essentially, preexcitation syndrome is the presence of an accessory pathway in the heart, which can lead to serious consequences, ranging from atrioventricular reentrant tachycardia to sudden cardiac death. Wolff-Parkinson-White syndrome is the most common preexcitation syndrome. AIM OF THE STUDY The aim of the study was to evaluate the clinical course of the disease, as well as the treatment of children and adolescents hospitalized in the Department of Pediatric Cardiology in the years 2008-2015. MATERIALS AND METHODS The study was carried out in 45 children (62 % male, 38% female; the mean age 11 years). During the study we analyzed 12-lead ECG, 24-hour Holter ECG, echocardiography and the cycloergometric exercise test. The results of treatment were also discussed. RESULTS Apart from the typical features of preexcitation, the most prevalent abnormality found in ECG was atrioventricular reentrant tachycardia. In 24-hour Holter ECG the most frequently detected disorders were premature ventricular beats and premature atrial contractions. Structural heart defects were detected in 8.9% of the children. The cycloergometric exercise test was positive in 8.9% of patients. The mean duration of symptoms before the diagnosis was 2.5 years. 25% of the patients were asymptomatic. 42.2% of the children needed antiarrhythmic therapy, while 44.4% had accessory pathways ablated. CONCLUSIONS The most common symptom of preexcitation in the study group were heart palpitations. The most frequent type of arrhythmia in children with preexcitation syndrome was orthodromic atrioventricular reentrant tachycardia. For the majority of older children ablation of the accessory pathway was a recommended form of treatment. In younger children the standard preventive pharmacological treatment was applied for 6 to 12 months.
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Affiliation(s)
- Aleksandra Stasiak
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, LodzPoland,Aleksandra Stasiak Department of Pediatric Cardiology and Rheumatology ul. Sporna 36/50, 91-738 Łódź tel. (+48 42) 617-77-00
| | | | - Piotr Kędziora
- Department of Pediatric Cardiology and Rheumatology, Medical University of Lodz, LodzPoland
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Sumitomo N, Horigome H, Miura M, Ono H, Ueda H, Takigiku K, Yoshimoto J, Ohashi N, Suzuki T, Sagawa K, Ushinohama H, Takahashi K, Miyazaki A, Sakaguchi H, Iwamoto M, Takamuro M, Tokunaga C, Nagano T. Study design for control of HEART rate in inFant and child tachyarrhythmia with heart failure Using Landiolol (HEARTFUL): A prospective, multicenter, uncontrolled clinical trial. J Cardiol 2017; 70:232-237. [PMID: 28073682 DOI: 10.1016/j.jjcc.2016.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/29/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persistent tachycardia in pediatric patients after congenital heart surgery further deteriorates their hemodynamic condition, and may become fatal. Therefore, immediate control of the tachycardia is mandatory in these patients. For this purpose, quick-acting, short-acting, titratable intravenous agents are required. However, there are no agents with such characteristics among the drugs approved for control of pediatric arrhythmias in Japan, and thus novel and effective medications for these patients are awaited. Landiolol, an ultrashort-acting β-blocker, was approved in 2013 for tachyarrhythmias in adult patients with heart failure. However, its efficacy and safety in pediatric patients remain unclear. The aim of this prospective, multicenter, open-label phase IIb/III study is to investigate the efficacy and safety of landiolol in pediatric patients with tachyarrhythmias as well as heart failure. METHODS Eligible patients are aged ≥ 3 months and <15 years, and have tachyarrhythmia (atrial fibrillation, atrial flutter, supraventricular tachycardia) as well as heart failure. The primary endpoint of the study is ≥20% reduction from baseline heart rate or return to normal sinus rhythm within 2h after starting intravenous administration of landiolol. Patients will receive intravenous infusion of landiolol, starting at 1μg/kg/min. The dose will be increased by 1μg/kg/min every 15-20min until the tachycardia rate has decreased by >20% or tachycardia has terminated, and the dose will then be maintained or further increased depending on the patient's condition. The study was started in April 2015 and will end within a few years. CONCLUSIONS The study was designed and designated the "HEARTFUL study" in the hope of establishing a basis for control of HEART rate in inFant and child tachyarrhythmia Using Landiolol in children with heart failure.
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Affiliation(s)
- Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Masaru Miura
- Division of Cardiology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hideaki Ueda
- Department of Cardiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Kiyohiro Takigiku
- Department of Pediatric Cardiology, Nagano Children's Hospital, Azumino, Japan
| | - Jun Yoshimoto
- Department of Pediatric Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Naoki Ohashi
- Department of Pediatric Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Tsugutoshi Suzuki
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Osaka, Japan
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital Medical Center, Fukuoka, Japan
| | - Hiroya Ushinohama
- Department of Pediatric Cardiology, Fukuoka Children's Hospital Medical Center, Fukuoka, Japan
| | - Kazuhiro Takahashi
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, Okinawa, Japan
| | - Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mari Iwamoto
- Department of Pediatrics, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Motoki Takamuro
- Department of Pediatric Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Japan
| | - Chiho Tokunaga
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Bédard P, Goyer I. Discontinuation of paediatric injectable digoxin: A loss for optimal drug therapy in children. Paediatr Child Health 2016; 21:127-8. [PMID: 27398048 DOI: 10.1093/pch/21.3.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
In early 2015, the paediatric formulation of injectable digoxin (50 μg/mL) was discontinued in Canada. The only remaining injectable formulation is five times more concentrated. This recent event has major implications for paediatric hospitals all over the country. The use of a more concentrated formulation is of particular concern in low-weight infants because the required volumes of digoxin are almost impossible to draw precisely. Such a situation is problematic because of the narrow therapeutic index of digoxin. There are different ways to deal with this inconvenient situation; however, none is as efficient or safe for infants as the discontinued formulation. The authors believe it remains imperative that patients requiring intravenous digoxin be treated with the safest and most efficient formulation possible, regardless of their age or size.
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Beaty RS, Moffett BS, Hall S, Kim J. Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients. Pediatr Cardiol 2015; 36:1465-9. [PMID: 25981562 DOI: 10.1007/s00246-015-1187-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Abstract
Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating room (n = 23), and nearly half (n = 19) of all patients were discharged home on an antiarrhythmic medication. A high incidence of adverse events was associated with intraoperative administration of antiarrhythmic medications.
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Affiliation(s)
- Rachel S Beaty
- Department of Pharmacy, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA
| | - Brady S Moffett
- Department of Pharmacy, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA. .,Baylor College of Medicine, Houston, TX, USA.
| | - Stuart Hall
- Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Kim
- Baylor College of Medicine, Houston, TX, USA
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