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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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Peng G, Zei PC. Diagnosis and Management of Paroxysmal Supraventricular Tachycardia. JAMA 2024; 331:601-610. [PMID: 38497695 DOI: 10.1001/jama.2024.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Importance Paroxysmal supraventricular tachycardia (PSVT), defined as tachyarrhythmias that originate from or conduct through the atria or atrioventricular node with abrupt onset, affects 168 to 332 per 100 000 individuals. Untreated PSVT is associated with adverse outcomes including high symptom burden and tachycardia-mediated cardiomyopathy. Observations Approximately 50% of patients with PSVT are aged 45 to 64 years and 67.5% are female. Most common symptoms include palpitations (86%), chest discomfort (47%), and dyspnea (38%). Patients may rarely develop tachycardia-mediated cardiomyopathy (1%) due to PSVT. Diagnosis is made on electrocardiogram during an arrhythmic event or using ambulatory monitoring. First-line acute therapy for hemodynamically stable patients includes vagal maneuvers such as the modified Valsalva maneuver (43% effective) and intravenous adenosine (91% effective). Emergent cardioversion is recommended for patients who are hemodynamically unstable. Catheter ablation is safe, highly effective, and recommended as first-line therapy to prevent recurrence of PSVT. Meta-analysis of observational studies shows single catheter ablation procedure success rates of 94.3% to 98.5%. Evidence is limited for the effectiveness of long-term pharmacotherapy to prevent PSVT. Nonetheless, guidelines recommend therapies including calcium channel blockers, β-blockers, and antiarrhythmic agents as management options. Conclusion and Relevance Paroxysmal SVT affects both adult and pediatric populations and is generally a benign condition. Catheter ablation is the most effective therapy to prevent recurrent PSVT. Pharmacotherapy is an important component of acute and long-term management of PSVT.
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Affiliation(s)
- Gary Peng
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paul C Zei
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Ganea G, Cinteză EE, Filip C, Iancu MA, Balta MD, Vătășescu R, Vasile CM, Cîrstoveanu C, Bălgrădean M. Postoperative Cardiac Arrhythmias in Pediatric and Neonatal Patients with Congenital Heart Disease-A Narrative Review. Life (Basel) 2023; 13:2278. [PMID: 38137879 PMCID: PMC10744555 DOI: 10.3390/life13122278] [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: 10/06/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Cardiac arrhythmias are a frequent complication in the evolution of patients with congenital heart disease. Corrective surgery for these malformations is an additional predisposition to the appearance of arrhythmias. Several factors related to the patient, as well as to the therapeutic management, are involved in the etiopathogenesis of cardiac arrhythmias occurring post-operatively. The risk of arrhythmias in the immediate postoperative period is correlated with the patient's young age and low weight at surgery. The change in heart geometry, hemodynamic stress, and post-surgical scars represent the main etiopathogenic factors that can contribute to the occurrence of cardiac arrhythmias in the population of patients with operated-on congenital heart malformations. Clinical manifestations differ depending on the duration of the arrhythmia, underlying structural defects, hemodynamic conditions, and comorbidities. The accurate diagnosis and the establishment of specific management options strongly influence the morbidity and mortality associated with arrhythmias. As such, identifying the risk factors for the occurrence of cardiac arrhythmias in the case of each patient is essential to establish a specific follow-up and management plan to improve the life expectancy and quality of life of children.
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Affiliation(s)
- Gabriela Ganea
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Eliza Elena Cinteză
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Cristina Filip
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
| | - Mihaela Adela Iancu
- Department of Internal Medicine, Family Medicine and Labor Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 20382 Bucharest, Romania
| | - Mihaela Daniela Balta
- Department of Internal Medicine, Family Medicine and Labor Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- “Alessandrescu-Rusescu” National Institute for Mother and Child Health, 20382 Bucharest, Romania
| | - Radu Vătășescu
- Emergency Clinical Hospital, 014461 Bucharest, Romania
- Cardio-Thoracic Department, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France;
| | - Cătălin Cîrstoveanu
- Department of Neonatal Intensive Care, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Neonatal Intensive Care Unit, M.S. Curie Children’s Clinical Hospital, 041451 Bucharest, Romania
| | - Mihaela Bălgrădean
- Department of Pediatrics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.G.); (E.E.C.); (C.F.); (M.B.)
- “Marie Skolodowska Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania
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4
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Ciriello GD, Colonna D, Papaccioli G, Correra A, Romeo E, Palladino MT, Cioppa ND, Russo MG, Sarubbi B. Triple Antiarrhythmic Therapy in Newborns with Refractory Atrioventricular Reentrant Tachycardia. Pediatr Cardiol 2023; 44:1040-1049. [PMID: 37093256 DOI: 10.1007/s00246-023-03162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Atrioventricular reentrant tachycardia (AVRT) is the most common form of supraventricular tachycardia in newborns. AVRT is sometimes refractory to conventional antiarrhythmic therapy. We describe our experience about the use of the triple combination of flecainide + propranolol + amiodarone as third-line regimen for refractory and recurrent AVRT in newborns. We considered a series of 14 patients who had failed both first-line and second-line therapy and were treated using the combination of flecainide + propranolol + amiodarone. Transoesophageal electrophysiologic study (TES) was performed to test the effectiveness of medical therapy during hospitalization and to try to reduce the amount of therapy, after amiodarone wash-out, before 1 year of age. TES was repeated at 1 year of age to test the spontaneous resolution of the arrhythmia after treatment discontinuation. Rhythm control was achieved in all 14 patients. At a mean age of 9.3 ± 2 months, AVRT was not inducible by TES in 11/12 amiodarone-free patients. At a mean age of 14.1 ± 3 months, AVRT was still inducible in 7/12 patients after interrupting the entire antiarrhythmic therapy (58.3%). Triple combination was effective as third-line option to suppress AVRT refractory to single and double antiarrhythmic therapy, with no significant adverse events. Our experience suggests that triple therapy could be maintained for a short-term treatment, discontinuing amiodarone before 1 year of age to avoid long-term side effects. Newborns who needed triple therapy appear to have a lower chance of accessory pathway disappearance at 1 year of age. TES could be useful for risk stratification of recurrences at the time of drug discontinuation in infants considered to be at higher risk of recurrent AVRT.
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Affiliation(s)
- Giovanni Domenico Ciriello
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy.
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy.
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy
| | - Giovanni Papaccioli
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Anna Correra
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Emanuele Romeo
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
| | | | - Nadia Della Cioppa
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy
| | - Maria Giovanna Russo
- Pediatric Cardiology Unit, Monaldi Hospital, "L.Vanvitelli" University, Naples, Italy
| | - Berardo Sarubbi
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Via Leonardo Bianchi, 80131, Naples, Italy
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5
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Ono K, Iwasaki Y, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki‐Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. J Arrhythm 2022; 38:833-973. [PMID: 36524037 PMCID: PMC9745564 DOI: 10.1002/joa3.12714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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6
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Ono K, Iwasaki YK, Akao M, Ikeda T, Ishii K, Inden Y, Kusano K, Kobayashi Y, Koretsune Y, Sasano T, Sumitomo N, Takahashi N, Niwano S, Hagiwara N, Hisatome I, Furukawa T, Honjo H, Maruyama T, Murakawa Y, Yasaka M, Watanabe E, Aiba T, Amino M, Itoh H, Ogawa H, Okumura Y, Aoki-Kamiya C, Kishihara J, Kodani E, Komatsu T, Sakamoto Y, Satomi K, Shiga T, Shinohara T, Suzuki A, Suzuki S, Sekiguchi Y, Nagase S, Hayami N, Harada M, Fujino T, Makiyama T, Maruyama M, Miake J, Muraji S, Murata H, Morita N, Yokoshiki H, Yoshioka K, Yodogawa K, Inoue H, Okumura K, Kimura T, Tsutsui H, Shimizu W. JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias. Circ J 2022; 86:1790-1924. [DOI: 10.1253/circj.cj-20-1212] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Yu-ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masaharu Akao
- Department of Cardiovascular Medicine, National Hospital Organization Kyoto Medical Center
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine
| | - Kuniaki Ishii
- Department of Pharmacology, Yamagata University Faculty of Medicine
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshinori Kobayashi
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | | | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | | | - Tetsushi Furukawa
- Department of Bio-information Pharmacology, Medical Research Institute, Tokyo Medical and Dental University
| | - Haruo Honjo
- Research Institute of Environmental Medicine, Nagoya University
| | - Toru Maruyama
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital
| | - Yuji Murakawa
- The 4th Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital
| | - Masahiro Yasaka
- Department of Cerebrovascular Medicine and Neurology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University School of Medicine
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mari Amino
- Department of Cardiovascular Medicine, Tokai University School of Medicine
| | - Hideki Itoh
- Division of Patient Safety, Hiroshima University Hospital
| | - Hisashi Ogawa
- Department of Cardiology, National Hospital Organisation Kyoto Medical Center
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Chizuko Aoki-Kamiya
- Department of Obstetrics and Gynecology, National Cerebral and Cardiovascular Center
| | - Jun Kishihara
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Eitaro Kodani
- Department of Cardiovascular Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Komatsu
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine
| | | | | | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
| | - Shinya Suzuki
- Department of Cardiovascular Medicine, The Cardiovascular Institute
| | - Yukio Sekiguchi
- Department of Cardiology, National Hospital Organization Kasumigaura Medical Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Noriyuki Hayami
- Department of Fourth Internal Medicine, Teikyo University Mizonokuchi Hospital
| | | | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University, Faculty of Medicine
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Mitsunori Maruyama
- Department of Cardiovascular Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Junichiro Miake
- Department of Pharmacology, Tottori University Faculty of Medicine
| | - Shota Muraji
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | | | - Norishige Morita
- Division of Cardiology, Department of Medicine, Tokai University Hachioji Hospital
| | - Hisashi Yokoshiki
- Department of Cardiovascular Medicine, Sapporo City General Hospital
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, Calkins H, Corrado D, Deftereos SG, Diller GP, Gomez-Doblas JJ, Gorenek B, Grace A, Ho SY, Kaski JC, Kuck KH, Lambiase PD, Sacher F, Sarquella-Brugada G, Suwalski P, Zaza A. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2021; 41:655-720. [PMID: 31504425 DOI: 10.1093/eurheartj/ehz467] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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8
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Capponi G, Belli G, Giovannini M, Remaschi G, Brambilla A, Vannuccini F, Favilli S, Porcedda G, De Simone L. Supraventricular tachycardias in the first year of life: what is the best pharmacological treatment? 24 years of experience in a single centre. BMC Cardiovasc Disord 2021; 21:137. [PMID: 33722203 PMCID: PMC7958399 DOI: 10.1186/s12872-020-01843-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/27/2020] [Indexed: 11/22/2022] Open
Abstract
Background Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life. Methods From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide or amiodarone when ineffective. Results The patients’ median follow-up time was 35 months. In re-entry tachycardias, flecainide was effective as monotherapy in 23/45 patients (51.1%) and in 20/45 patients (44.4%) in combination with nadolol, sotalol or digoxin (overall 95.5%). In automatic tachycardias, a beta-blocker alone was effective in 3/10 patients (30.0%), however, the best results were obtained when combined with flecainide: overall 9/10 (90%). Conclusions In this retrospective study on pharmacological treatment of SVTs under 1 year of age the combination of flecainide and beta-blockers was highly effective in long-term maintenance of sinus rhythm in both re-entry and automatic tachycardias.
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Affiliation(s)
- Guglielmo Capponi
- Department of Health Sciences, Post-Graduate School of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Gilda Belli
- Department of Health Sciences, Post-Graduate School of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Mattia Giovannini
- Department of Health Sciences, Post-Graduate School of Paediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Giulia Remaschi
- Neonatology Department and Neonatal Intensive Care Unit, Careggi University Hospital, Florence, Italy
| | - Alice Brambilla
- Cardiology Unit, Anna Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy
| | - Francesca Vannuccini
- Cardiology Unit, Anna Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy
| | - Silvia Favilli
- Cardiology Unit, Anna Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy
| | - Giulio Porcedda
- Cardiology Unit, Anna Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy
| | - Luciano De Simone
- Cardiology Unit, Anna Meyer Children's University Hospital, Viale Gaetano Pieraccini 24, 50139, Florence, Italy.
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9
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Cazzoli I, Till J, Rowlinson G, Wong L. Supraventricular Tachycardia in a Neonate Repeatedly Induced by Ectopic Ventricular Couplet During Breast-feeding. Indian J Pediatr 2021; 88:188. [PMID: 32607668 DOI: 10.1007/s12098-020-03431-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ilaria Cazzoli
- Pediatric Electrophysiology and Inherited Cardiac Conditions, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK.
| | - J Till
- Pediatric Electrophysiology and Inherited Cardiac Conditions, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK
| | - G Rowlinson
- Pediatric Unit, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK
| | - L Wong
- Pediatric Electrophysiology and Inherited Cardiac Conditions, Department of Pediatrics, Royal Brompton Hospital & Harefield Hospital, London, UK
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10
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Safety and Efficacy of Landiolol Hydrochloride in Children with Tachyarrhythmia of Various Etiologies. Pediatr Cardiol 2021; 42:1700-1705. [PMID: 34097085 PMCID: PMC8557176 DOI: 10.1007/s00246-021-02653-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/26/2021] [Indexed: 10/25/2022]
Abstract
The safety and efficacy of landiolol have not been fully elucidated in pediatric patients. This study aimed to clarify the safety and efficacy of landiolol in a pediatric cohort. We retrospectively assessed the clinical features of 21 pediatric patients who were administered landiolol at our hospital. We also investigated the rates of sinus rhythm conversion and heart rate response. The median patient age was 7 months (interquartile range 1-13 months). The etiology of tachyarrhythmia was junctional ectopic tachycardia in 10 patients (47.6%), atrial tachycardia in 10 patients (47.6%), and ventricular tachycardia in 1 patient (4.8%). Of the 21 children, 18 (85.7%) had congenital heart defects, including 14 (77.8%) in whom a landiolol infusion was performed perioperatively. The landiolol infusion was effective in 18 pediatric patients (85.7%), as measured by the conversion to sinus rhythm or a reduced heart rate. Atrial tachycardia in the perioperative period was terminated in all patients. Of 7 patients with tachyarrhythmias unrelated to the perioperative period, landiolol was effective in 5. No adverse effects were reported in any patient. Landiolol infusion is effective and safe in pediatric patients with tachyarrhythmia of various etiologies, especially those with atrial tachyarrhythmia during the perioperative period.
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11
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Bjeloševič M, Illíková V, Tomko J, Olejník P, Chalupka M, Hatala R. Supraventricular tachyarrhythmias during the intrauterine, neonatal, and infant period: A 10-year population-based study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:680-686. [PMID: 32459027 DOI: 10.1111/pace.13964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/07/2020] [Accepted: 05/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to evaluate the incidence, type, and management of supraventricular tachyarrhythmias (SVT) during the first year of life in a retrospective, population-based, single-center study during a 10-year period. METHODS The analyzed patient cohort is based on data from the only specialized center managing all cases of neonatal and infant SVTs between 2009 and 2018 in the Slovak Republic (5.5 million population). A total of 116 consecutive patients <366 days old were included in the study. RESULTS Calculated SVT incidence ratio was 1:4500 in the first year of life. AV reentry tachycardia was the leading arrhythmia (49%). SVT in this specific population was frequently a transient problem with spontaneous resolution in 87% of patients during a median 3-year follow up. Congenital heart disease was common (16%). Intrauterine treatment by drugs administered to mother was safe and effective in preventing unnecessary cesarean deliveries. In arrhythmia termination, amiodarone and propafenone were equally safe and effective, with possible more favorable pharmacodynamics of the former. For prophylactic treatment, sotalol and propafenone were equally safe and effective and became the preferred basis of long-term drug therapy in our center. However, this therapy requires intensive monitoring during its initiation. CONCLUSION The prognosis of SVT in the first year of life is good: with optimized pharmacological treatment, the need for early catheter ablation and mortality rate are low (<1%) and there is a high rate of spontaneous arrhythmia resolution. Heart failure is a possible predictor of arrhythmia persistence with need for ablation in later life.
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Affiliation(s)
- Marko Bjeloševič
- Department of Paediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Department of Arrhythmias and Cardiac Pacing, Pediatric Cardiac Center, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Viera Illíková
- Department of Arrhythmias and Cardiac Pacing, Pediatric Cardiac Center, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Jaroslav Tomko
- Department of Paediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Department of Arrhythmias and Cardiac Pacing, Pediatric Cardiac Center, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Peter Olejník
- Department of Paediatric Cardiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Department of Pediatric Cardiology, Pediatric Cardiac Center, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Michal Chalupka
- Department of Arrhythmias and Cardiac Pacing, Pediatric Cardiac Center, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Robert Hatala
- Department of Cardiology and Angiology, Slovak Medical University, Bratislava, Slovakia.,Department of Arrhythmias and Cardiac Pacing, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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12
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Bhimani SA, Rao S, Nadorlik H, Saarel EV, Aziz PF. Flecainide toxicity in renal tubular acidosis type IV treated with extracorporeal membrane oxygenation. HeartRhythm Case Rep 2020; 6:287-289. [PMID: 32461897 PMCID: PMC7244634 DOI: 10.1016/j.hrcr.2020.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Salima Ahmed Bhimani
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Sruti Rao
- Department of Cardiology, Nemours Children's Health System, Wilmington, Delaware
| | - Holly Nadorlik
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Elizabeth V Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
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13
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Refaat M, El Dick J, Sabra M, Bitar F, Tayeh C, Abutaqa M, Arabi M. Sotalol as an effective adjunct therapy in the management of supraventricular tachycardia induced fetal hydrops fetalis. J Neonatal Perinatal Med 2020; 13:267-273. [PMID: 31707376 DOI: 10.3233/npm-190268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sustained fetal supraventricular tachycardia (SVT) complicated by hydrops fetalis carries a significant risk of morbidity and mortality. While there is no clear consensus on first- and second-line therapy options for the management of fetal SVT with or without hydrops fetalis, there exists significant nonrandomized experience with a number of antiarrhythmic agents that has founded the basis for management. Furthermore, recently published meta-analyses and ongoing multicenter prospective studies have aimed to bridge the gap in the literature. We report two cases of sustained fetal SVT with severe secondary hydrops fetalis managed successfully with flecainide-sotalol combination therapy in one case and sotalol-digoxin combination therapy in the second and review the literature for the management of fetal SVT.
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Affiliation(s)
- Marwan Refaat
- Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Joud El Dick
- Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Mohammad Sabra
- Department of Internal Medicine, American University of Beirut Medical Center, Division of Cardiology, Beirut, Lebanon
| | - Fadi Bitar
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christelle Tayeh
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Abutaqa
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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14
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Srinivasan C, Balaji S. Neonatal supraventricular tachycardia. Indian Pacing Electrophysiol J 2019; 19:222-231. [PMID: 31541680 PMCID: PMC6904811 DOI: 10.1016/j.ipej.2019.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/13/2019] [Indexed: 11/23/2022] Open
Abstract
Supraventricular tachycardia (SVT) is one of the most common conditions requiring emergency cardiac care in neonates. Atrioventricular reentrant tachycardia utilizing an atrioventricular bypass tract is the most common form of SVT presenting in the neonatal period. There is high likelihood for spontaneous resolution for most of the common arrhythmia substrates in infancy. Pharmacological agents remain as the primary therapy for neonates.
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Affiliation(s)
- Chandra Srinivasan
- Section of Pediatric & Adult Congenital Cardiac Electrophysiology, Division of Pediatric Cardiology, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, USA.
| | - Seshadri Balaji
- Division of Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA.
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15
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Flecainide: Electrophysiological properties, clinical indications, and practical aspects. Pharmacol Res 2019; 148:104443. [PMID: 31493514 DOI: 10.1016/j.phrs.2019.104443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/03/2019] [Accepted: 09/03/2019] [Indexed: 12/19/2022]
Abstract
Over the last 35 years, flecainide proved itself one of the most commonly used arrhythmic drugs, expanding its original indication for ventricular arrhythmias and results nowadays as the cornerstone of the rhythm control strategy in atrial fibrillation management of patients without structural heart disease. While the increased mortality associated with flecainide in the Cardiac Arrhythmia Suppression Trial (CAST) still casts his shadow over flecainide clinical profile, this compound has subsequently demonstrated safe and is now used successfully for a plethora of indications, including pharmacological cardioversion of atrial fibrillation, cathecolaminergic polymorphic ventricular tachycardia, supraventricular tachyarrhythmias and ventricular pre-excitation. Moreover, the recent marketing of a controlled release formulation, along with the intravenous and immediate release formulations, increased the armamentarium to the clinician's disposal while improving patients' compliance. In the present paper, we offer a comprehensive review of the anti-arrhythmic effects of flecainide, detailing its electrophysiological properties, its effects on the conduction system, its clinical use and the major side effects and contraindications in clinical practice.
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16
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Sakurai K, Takahashi K, Nakayashiro M. Combined flecainide and sotalol therapy for multifocal atrial tachycardia in cardio-facio-cutaneous syndrome. Pediatr Int 2018; 60:1036-1037. [PMID: 30536490 DOI: 10.1111/ped.13695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/14/2018] [Accepted: 07/11/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Kenzo Sakurai
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, Okinawa, Japan
| | - Kazuhiro Takahashi
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, Okinawa, Japan
| | - Mami Nakayashiro
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, Okinawa, Japan
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17
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If necessary, use antiarrhythmic drugs to treat acute and chronic supraventricular tachycardia in infants. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0528-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Valdés SO, Miyake CY, Niu MC, de la Uz CM, Asaki SY, Landstrom AP, Schneider AE, Rusin CG, Patel R, Lam WW, Kim JJ. Early experience with intravenous sotalol in children with and without congenital heart disease. Heart Rhythm 2018; 15:1862-1869. [PMID: 30003959 DOI: 10.1016/j.hrthm.2018.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Arrhythmias are common in the pediatric population. In patients unable to take oral medications or in need of acute therapy, options of intravenous (IV) antiarrhythmic medications are limited. Recently IV sotalol has become readily available, but experience in children is limited. OBJECTIVE The purpose of this study was to describe our initial experience with the use of IV sotalol in the pediatric population. METHODS A retrospective study of all pediatric patients receiving IV sotalol was performed. Patient demographic characteristics, presence of congenital heart disease, arrhythmia type, efficacy of IV sotalol use, and adverse effects were evaluated. RESULTS A total of 47 patients (26 (55%) male and 24 (51%) with congenital heart disease) received IV sotalol at a median age of 2.05 years (interquartile range 0.07-10.03 years) and a median weight of 12.8 kg (interquartile range 3.8-34.2 kg), and 13 (28%) received IV sotalol in the acute postoperative setting. Supraventricular arrhythmias occurred in 40 patients (85%) and ventricular tachycardia in 7 (15%). Among 24 patients receiving IV sotalol for an active arrhythmia, acute termination was achieved in 21 (88%). Twenty-three patients received IV sotalol as maintenance therapy for recurrent arrhythmias owing to inability to take oral antiarrhythmic medications; 19 (83%) were controlled with sotalol monotherapy. No patient required discontinuation of IV sotalol secondary to adverse effects, proarrhythmia, or QT prolongation. CONCLUSION IV sotalol is an effective antiarrhythmic option for pediatric patients and may be an excellent agent for acute termination of active arrhythmias. It was well tolerated, with no patient requiring discontinuation secondary to adverse effects.
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Affiliation(s)
- Santiago O Valdés
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
| | - Christina Y Miyake
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Mary C Niu
- Oklahoma Children's Heart Center, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma
| | - Caridad M de la Uz
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - S Yukiko Asaki
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Andrew P Landstrom
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Andrew E Schneider
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Craig G Rusin
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | - Wilson W Lam
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey J Kim
- Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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19
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Abstract
Supraventricular tachycardia is the most common tachyarrhythmia encountered in infants. In older children and adults, definitive treatment of the supraventricular tachycardia substrate with catheter ablation is a common approach to management. However, in infants, the risks of catheter ablation are significantly higher, and the patients often outgrow the potential to experience episodes. Therefore, antiarrhythmic medications are often utilized to minimize the likelihood of experiencing episodes. This article reviews the common arrhythmia mechanisms encountered in infants and the medications used to treat these patients.
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20
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Ban JE. Neonatal arrhythmias: diagnosis, treatment, and clinical outcome. KOREAN JOURNAL OF PEDIATRICS 2017; 60:344-352. [PMID: 29234357 PMCID: PMC5725339 DOI: 10.3345/kjp.2017.60.11.344] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/31/2017] [Accepted: 09/04/2017] [Indexed: 11/27/2022]
Abstract
Arrhythmias in the neonatal period are not uncommon, and may occur in neonates with a normal heart or in those with structural heart disease. Neonatal arrhythmias are classified as either benign or nonbenign. Benign arrhythmias include sinus arrhythmia, premature atrial contraction, premature ventricular contraction, and junctional rhythm; these arrhythmias have no clinical significance and do not need therapy. Supraventricular tachycardia, ventricular tachycardia, atrioventricular conduction abnormalities, and genetic arrhythmia such as congenital long-QT syndrome are classified as nonbenign arrhythmias. Although most neonatal arrhythmias are asymptomatic and rarely life-threatening, the prognosis depends on the early recognition and proper management of the condition in some serious cases. Precise diagnosis with risk stratification of patients with nonbenign neonatal arrhythmia is needed to reduce morbidity and mortality. In this article, I review the current understanding of the common clinical presentation, etiology, natural history, and management of neonatal arrhythmias in the absence of an underlying congenital heart disease.
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Affiliation(s)
- Ji-Eun Ban
- Division of Cardiology, Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea
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21
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Ge H, Li X, Liu H, Jiang H. Predictors of Pharmacological Therapy of Ectopic Atrial Tachycardia in Children. Pediatr Cardiol 2017; 38:289-295. [PMID: 27882422 DOI: 10.1007/s00246-016-1511-7] [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: 06/30/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
Abstract
Ectopic atrial tachycardia (EAT) is a relatively common type of supraventricular tachycardia in the pediatric population, and it can be resistant to antiarrhythmic drugs and lead to tachycardia-induced cardiomyopathy (TIC) if not properly managed. The purpose of this study was to determine the predictors of the response to pharmacological therapy in children with EAT. From January 2009 to April 2014, 115 children were admitted to our hospital with a diagnosis of EAT and placed on antiarrhythmic drugs. We examined the clinical history, response to therapy, and follow-up of the children. The incidence of TIC secondary to EAT was 22.6% (n = 26) in children. Incessant EAT accounted for 44.3% of all patients. Control of EAT with antiarrhythmic therapy was achieved in 73.9% (n = 85) of the children. The combination of sotalol and propafenone performed well in controlling EAT in children [complete control in 35 (49.3%) of 71]. The mean time of conversion to sinus rhythm was 24 days, and the mean duration of therapy was 11 months in children with resolution. Multivariate predictors of the control of EAT were age at presentation (OR 0.289, P = 0.038) and tachycardia type (OR 0.276, P = 0.006). TIC occurs in 22.6% of children with EAT. Incessant EAT is more frequently complicated by TIC. Independent factors associated with a good response to pharmacological therapy include a younger age at presentation and non-incessant tachycardia in children with EAT.
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Affiliation(s)
- Haiyan Ge
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, China.,Beijing Huaxin Hospital, Beijing, 100016, China
| | - Xiaomei Li
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, China. .,Beijing Huaxin Hospital, Beijing, 100016, China.
| | - Haiju Liu
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, China.,Beijing Huaxin Hospital, Beijing, 100016, China
| | - He Jiang
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, China.,Beijing Huaxin Hospital, Beijing, 100016, China
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22
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Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in Cardiac Critical Care Antiarrhythmics. Pediatr Crit Care Med 2016; 17:S49-58. [PMID: 26945329 DOI: 10.1097/pcc.0000000000000620] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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23
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Chu PY, Hill KD, Clark RH, Smith PB, Hornik CP. Treatment of supraventricular tachycardia in infants: Analysis of a large multicenter database. Early Hum Dev 2015; 91:345-50. [PMID: 25933212 PMCID: PMC4433846 DOI: 10.1016/j.earlhumdev.2015.04.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 02/27/2015] [Accepted: 04/09/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Supraventricular tachycardia (SVT) is the most common arrhythmia in infants. Infants are typically treated with antiarrhythmic medications, but there is a lack of evidence guiding management, thus exposing infants to risks of both inadequate therapy and medication adverse events. We used data from a large clinical database to better understand current practices in SVT management, safety of commonly used medications, and outcomes of hospitalized infants treated for SVT. METHODS This retrospective data analysis included all infants discharged from Pediatrix Medical Group neonatal intensive care units between 1998 and 2012 with a diagnosis of SVT who were treated with antiarrhythmic medications. We categorized infants by the presence of congenital heart disease other than patent ductus arteriosus. Medications were categorized as abortive, acute, or secondary prevention therapies. We used descriptive statistics to describe medication use, adverse events, and outcomes including SVT recurrence and mortality. RESULTS A total of 2848 infants with SVT were identified, of whom 367 (13%) had congenital heart disease. Overall, SVT in-hospital recurrence was high (13%), and almost one fifth of our cohort (18%) experienced an adverse event. Mortality was 2% in the overall cohort and 6% in the congenital heart disease group (p<0.001). Adenosine was the most commonly used abortive therapy, but there was significant practice variation in therapies used for acute treatment and secondary prevention of SVT. CONCLUSION AND PRACTICE IMPLICATION Significant variation in SVT treatment and suboptimal outcomes warrant future clinical trials to determine best practices in treating SVT in infants.
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Affiliation(s)
- Patricia Y Chu
- Duke Clinical Research Institute, Durham, NC, United States
| | - Kevin D Hill
- Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL, United States
| | - P Brian Smith
- Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, NC, United States; Department of Pediatrics, Duke University Medical Center, Durham, NC, United States.
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24
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Mano Y, Asakawa Y, Kita K, Ishii T, Hotta K, Kusano K. Validation of an ultra-performance liquid chromatography-tandem mass spectrometry method for the determination of flecainide in human plasma and its clinical application. Biomed Chromatogr 2015; 29:1399-405. [DOI: 10.1002/bmc.3437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/17/2014] [Accepted: 01/04/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Yuji Mano
- Drug Metabolism and Pharmacokinetics; Biopharmaceutical Assessment Core Function Unit; Eisai Co. Ltd, 1-3, 5-chome, Tokodai Tsukuba-shi Ibaraki 300-2635 Japan
| | - Yoshiki Asakawa
- Analysis group; Tsukuba Division; Sunplanet Co. Ltd, 1-3, 5-chome, Tokodai Tsukuba-shi Ibaraki 300-2635 Japan
| | - Kenji Kita
- Analysis group; Tsukuba Division; Sunplanet Co. Ltd, 1-3, 5-chome, Tokodai Tsukuba-shi Ibaraki 300-2635 Japan
| | - Takuho Ishii
- Analysis group; Tsukuba Division; Sunplanet Co. Ltd, 1-3, 5-chome, Tokodai Tsukuba-shi Ibaraki 300-2635 Japan
| | - Koichiro Hotta
- Drug Metabolism and Pharmacokinetics; Biopharmaceutical Assessment Core Function Unit; Eisai Co. Ltd, 1-3, 5-chome, Tokodai Tsukuba-shi Ibaraki 300-2635 Japan
| | - Kazutomi Kusano
- Drug Metabolism and Pharmacokinetics; Biopharmaceutical Assessment Core Function Unit; Eisai Co. Ltd, 1-3, 5-chome, Tokodai Tsukuba-shi Ibaraki 300-2635 Japan
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25
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van der Heijden LB, Oudijk MA, Manten GTR, ter Heide H, Pistorius L, Freund MW. Sotalol as first-line treatment for fetal tachycardia and neonatal follow-up. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:285-293. [PMID: 23303470 DOI: 10.1002/uog.12390] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 12/10/2012] [Accepted: 12/30/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES In fetal tachycardia, pharmacological therapy with digoxin, flecainide and sotalol has been reported to be effective. In a recent retrospective multicenter study, sotalol was considered to be less effective than the other drugs in treatment of fetal supraventricular tachycardia (SVT). The aim of this study was to re-evaluate the efficacy and safety of maternally administered sotalol in the treatment of fetal tachycardia. METHODS This was a retrospective review of the records of 30 consecutive fetuses with tachycardia documented on M-mode echocardiography between January 2004 and December 2010 at Wilhelmina Children's Hospital, a tertiary referral university hospital. Patients were subdivided into those diagnosed with supraventricular tachycardia and those with atrial flutter (AF) and presence of hydrops was noted. Other variables investigated included QTc interval measured on maternal electrocardiogram before and after initiation of antiarrhythmic therapy, fetal heart rhythm and heart rate pre- and postnatally, oral maternal drug therapy used, time to conversion to sinus rhythm (SR), percentage of fetuses converted following transplacental treatment, maternal adverse effects, presence or absence of tachycardia as noted on postnatal ECG, postnatal therapy or prophylaxis and neonatal outcome. Findings are discussed with reference to the literature. RESULTS A total of 28 patients (18 with SVT, 10 with AF) were treated with sotalol as first-line therapy. Fetal hydrops was present in six patients (five with SVT, one with AF). All hydropic patients converted antenatally to SR (67% with sotalol as a single-drug therapy, 33% after addition of flecainide). Of the non-hydropic patients, 91% converted to SR (90% with sotalol only, 10% after addition of flecainide or digoxin). In 9% (with AF) rate control was achieved. There was no mortality. No serious drug-related adverse events were observed. Postnatally, rhythm disturbances were detected in 10 patients, two of whom still had AF. In eight, SVT was observed within 3 weeks postnatally, and in five of these within 72 hours. CONCLUSIONS Sotalol can be recommended as the drug of first choice for treatment of fetal AF and has been shown to be an effective and safe first-line treatment option for SVT, at least in the absence of hydrops. Postnatal maintenance therapy after successful prenatal therapy is not necessarily indicated, as the risk of recurrence is low beyond 72 hours of age.
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Affiliation(s)
- L B van der Heijden
- Department of Pediatric Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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26
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Brugada J, Blom N, Sarquella-Brugada G, Blomstrom-Lundqvist C, Deanfield J, Janousek J, Abrams D, Bauersfeld U, Brugada R, Drago F, de Groot N, Happonen JM, Hebe J, Yen Ho S, Marijon E, Paul T, Pfammatter JP, Rosenthal E. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. ACTA ACUST UNITED AC 2013; 15:1337-82. [DOI: 10.1093/europace/eut082] [Citation(s) in RCA: 217] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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27
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Oral flecainide is effective in management of refractory tachycardia in infants. Indian Heart J 2013; 65:168-71. [PMID: 23647896 DOI: 10.1016/j.ihj.2013.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 02/03/2013] [Accepted: 02/14/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Propranolol and digoxin have been used as first line drugs for treatment of supraventricular tachycardia (SVT) in infants. Flecainide and other drugs have been effective as a second line treatment for controlling refractory SVT. MATERIAL AND METHODS This is a prospective study without randomization and control. The inclusion criteria were: infants (≤12 months) with tachyarrhythmia who failed to respond to first line drugs. Patients having post-surgical arrhythmias were excluded from the study. RESULTS A total of 8 infants were treated with flecainide for refractory tachyarrhythmia's. Diagnosis on electrocardiogram (ECG) was atrioventricular reentry tachycardia (AVRT) in 5, atrial ectopic tachycardia (AET) in 2, a combination of AVRT and atrioventricular nodal reentry tachycardia (AVNRT) in 1. All patients had failed trial of antiarrhythmic drugs prior to presentation: digoxin and propranolol in 7, amiodarone in 3, cardioversion in 1. Flecainide (80-130 mg/m(2) orally) resulted in termination of the tachycardia in all 8 patients. Acute pharmacological termination of arrhythmia occurred with oral flecainide loading in 1 and temporarily with intravenous esmolol loading in 1 patient. Adjuvant therapy in form of propranolol was used in 5 and digoxin in 2. There were no side effects noted. Four episodes of recurrence were noted in 3 patients over 2 years, all of which responded to dose increase. Mean follow up time is 24.75 months. CONCLUSION This small case series indicates that flecainide is an effective antiarrhythmic agent, free of side effects and when used orally is capable of terminating and controlling relatively resistant supraventricular tachycardia in children.
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Bonney WJ, Shah MJ. Incessant SVT in children: Ectopic atrial tachycardia and permanent junctional reciprocating tachycardia. PROGRESS IN PEDIATRIC CARDIOLOGY 2013. [DOI: 10.1016/j.ppedcard.2012.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
BACKGROUND Despite the increasing utilisation of interventional electrophysiology in adults and older children with arrhythmias, there are few data reflecting the safety and efficacy of this procedure in the age group under 2 years. AIM We describe our experience in assessing the efficacy and safety with this group of children. METHODS We undertook a retrospective review of all infants under 2 years of age who underwent an interventional electrophysiology procedure between 1995 and 2009 to determine indications, procedural details, short- and long-term success, and complication rate. RESULTS A total of 23 interventional electrophysiology procedures were performed in 17 patients initially under 2 years of age. Of these, three patients had congenital heart disease. The most common indication was arrhythmia resistant to pharmacological agents (59%), with the remaining cases being arrhythmia complicated by cardiovascular instability (41%). There was initial success in 15 patients after the first procedure, with early recurrence in four. Following six repeat procedures, there was long-term success in 15 patients (88%), with three repeat procedures being performed after 2 years of age. There was one non-procedural death related to persisting arrhythmia. There were three minor complications. In one patient, cryotherapy was used successfully. CONCLUSIONS The interventional electrophysiology procedure is a viable therapeutic option in infants under 2 years with arrhythmia resistant to other conventional medical management.
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Knudson JD, Cannon BC, Kim JJ, Moffett BS. High-dose sotalol is safe and effective in neonates and infants with refractory supraventricular tachyarrhythmias. Pediatr Cardiol 2011; 32:896-903. [PMID: 21553267 DOI: 10.1007/s00246-011-0010-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 04/22/2011] [Indexed: 11/28/2022]
Abstract
Our objective was to assess the efficacy and safety of high-dose sotalol in neonates and infants with refractory supraventricular tachycardia (SVT). SVT in neonates and infants can be refractory to primary therapies; therefore, secondary agents, e.g., sotalol, are often required to obtain control of SVT. Age-factor nomogram dosing of sotalol is widely used; however, our institution uses greater doses based on body surface area (approximately 150-200 mg/m(2)/d). A retrospective review of 78 inpatients receiving sotalol, after failing another antiarrthymic medication, at our institution from 2001 to 2008 was performed. Corrected QT intervals (QTc), 24-h Holter-monitoring results, and outpatient records were reviewed to assess safety and efficacy for patients ≤ 2 years of age. Median patient age at the time of initiation of therapy was 24 days (range 3-728). Forty-eight patients (62%) were neonates, and 36 (46%) had congenital heart disease. The median sotalol dosage was 152 mg/m(2)/day (range 65-244). The SVT of 70 patients (90%) was controlled with sotalol. No patients experienced significant QTc prolongation or proarrhythmia. Mean duration of follow-up was 3.3 ± 0.24 years. High-dose sotalol allows for safe and rapid control of refractory tachyarrhythmias in this young age group.
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Affiliation(s)
- Jarrod D Knudson
- Department of Pediatric Cardiology, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin St, MC-19345-C, Houston, TX 77030, USA.
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LaPage MJ, Reed JH, Collins KK, Law IH, Pilcher TA, Tanel RE, Anderson CC, Young ML, Emmel M, Paul T, Blaufox AD, Arora G, Saul JP. Safety and results of cryoablation in patients <5 years old and/or <15 kilograms. Am J Cardiol 2011; 108:565-71. [PMID: 21624545 DOI: 10.1016/j.amjcard.2011.03.089] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/19/2022]
Abstract
Current recommendations discourage elective radiofrequency ablation in patients <5 years old and/or weighing <15 kg, primarily because of the greater complication rate. To describe the current use, complications, and immediate outcomes of cryoablation in this patient population, a multicenter retrospective review of all patients <5 years old and/or weighing <15 kg who were treated with cryoablation for arrhythmia was performed. Eleven centers contributed data for 68 procedures on 61 patients. Of those, 34% were elective and 24% (n = 16) were both cryoablation and radiofrequency ablation. The median age and weight at ablation was 3.5 years (range 8 days to 9.9 years) and 15.2 kg (range 2.3 to 23), respectively. Congenital heart disease was present in 23% of the patients. The immediate success rate of cryoablation alone was 74%. No major complications occurred with cryoablation only; however, 2 of the 16 patients who underwent cryoablation and radiofrequency ablation had major complications. Of the 50 patients receiving cryoablation, 8 (16%) had variable degrees of transient atrioventricular block. The recurrence rate was 20% after cryoablation and 30% after cryoablation plus radiofrequency ablation. In conclusion, cryoablation appears to have a high safety profile in these patients. Compared to older and larger patients, the efficacy of cryoablation in this small, young population was lower and the recurrence rates were higher. Cryoablation's effect on the coronary arteries has not been fully elucidated and requires additional research.
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Núñez F, Ruiz-Granell R, Martínez-Costa C, Morell S, Brines J. Safety and efficacy of flecainide in the treatment of symptomatic children with Wolff-Parkinson-White syndrome. Pediatr Cardiol 2010; 31:1162-5. [PMID: 20717658 DOI: 10.1007/s00246-010-9772-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 07/26/2010] [Indexed: 11/25/2022]
Abstract
Sudden cardiac death may occur in children with symptomatic and asymptomatic Wolff-Parkinson-White syndrome (WPWS). Symptomatic patients are usually treated with antiarrhythmic drugs until ablation of an accessory pathway (AP) could be performed. The objective of this study was to review the safety and efficacy of flecainide in the treatment of children with symptomatic WPWS. Twenty-two children (14 male) with WPWS and without structural heart disease were studied. AP location was achieved by electrophysiological testing or 12-lead electrocardiogram tracing. Symptomatic children (i.e., those frequent palpitations or supraventricular tachycardia episodes) received flecainide. Patients were followed-up for an average of 3.4 years until ablation of AP. Eighteen children reported clinical symptoms when first diagnosed, but only 13 initiated treatment during 16.23 months (range 1-55). Flecainide was effective in all patients: Seven became asymptomatic, and six experimented isolated episodes of palpitations. One child experienced hair loss as a side effect. AP location was as follows: left free wall (n = 7), right free wall (n = 4), posteroseptal (n = 8), and anteroseptal (n = 4). Ablation was performed without complications in 13 children. Symptomatic WPWS in children can be treated safely and efficiently with flecainide. It represents a good alternative therapy until AP ablation can be performed.
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Affiliation(s)
- Francisco Núñez
- Pediatric Cardiology Unit, Hospital Clínico Universitario of Valencia, 46010, Valencia, Spain.
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Chockalingam P, Clur SAB, Wilde AAM, Kuipers I, van Woensel J, Blom NA. Implantable cardioverter defibrillator as a bridge to recovery in an infant with cardiac rhabdomyoma. Eur J Pediatr 2009; 168:863-6. [PMID: 18815808 DOI: 10.1007/s00431-008-0837-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Accepted: 09/04/2008] [Indexed: 11/27/2022]
Abstract
Multiple cardiac rhabdomyomas in an infant presented with recurrent life-threatening ventricular arrhythmias refractory to medical treatment and necessitating the placement of an implantable cardioverter defibrillator (ICD). The device functioned effectively as a bridge to recovery during a 2-year follow-up period, when the tumor showed spontaneous regression, along with an almost complete resolution of the ventricular arrhythmias. We conclude that childhood cardiac rhabdomyomas causing severe drug-refractory ventricular arrhythmias can be managed by ICD therapy.
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Affiliation(s)
- Priya Chockalingam
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
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Chiu SN, Lu CW, Chang CW, Chang CC, Lin MT, Lin JL, Chen CA, Wang JK, Wu MH. Radiofrequency Catheter Ablation of Supraventricular Tachycardia in Infants and Toddlers. Circ J 2009; 73:1717-21. [DOI: 10.1253/circj.cj-09-0123] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shuenn-Nan Chiu
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Chun-Wei Lu
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | | | | | - Ming-Tai Lin
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Jiunn-Lee Lin
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Chun-An Chen
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Jou-Kou Wang
- Department of Pediatrics and Medicine, National Taiwan University Hospital
| | - Mei-Hwan Wu
- Department of Pediatrics and Medicine, National Taiwan University Hospital
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Schlechte EA, Boramanand N, Funk M. Supraventricular tachycardia in the pediatric primary care setting: Age-related presentation, diagnosis, and management. J Pediatr Health Care 2008; 22:289-99. [PMID: 18761230 DOI: 10.1016/j.pedhc.2007.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/20/2007] [Accepted: 08/21/2007] [Indexed: 11/25/2022]
Abstract
As many as 1 in 250 children experience supraventricular tachycardia (SVT), but its presentation is often vague and its symptoms mistakenly attributed to other common pediatric conditions. If SVT is correctly identified in a timely manner, most children will go on to live normal healthy lives. SVT is not covered in depth in most pediatric advanced practice nursing programs, but because of its prevalence, it should be familiar to all pediatric primary care providers. This article reviews common mechanisms of SVT and their age-related presentation, diagnosis, and management. A case study of an 8-year-old boy with SVT is presented.
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Skinner JR, Sharland G. Detection and management of life threatening arrhythmias in the perinatal period. Early Hum Dev 2008; 84:161-72. [PMID: 18358642 DOI: 10.1016/j.earlhumdev.2008.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 11/20/2022]
Abstract
The management of tachyarrhythmias and bradyarrythmias in the fetus requires a team approach with careful monitoring of fetal well-being as well as care in establishing a precise diagnosis with use of m-mode and Doppler echocardiography to determine the atrial and ventricular rate. A persistent fetal heart rate less than 80 beats per minute (bpm) suggests complete atrioventricular block. A persistent fetal heart rate over 180 bpm suggests pathological tachycardia, most of which are a supraventricular tachycardia mediated via an accessory pathway. However, around 20% are due to atrial flutter, and this review highlights why medical management should be different for these cases, and for those with hydrops or cardiac failure. It also illustrates which fetus or infant may be at particular risk, and illustrates key features in their management before and after birth.
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Affiliation(s)
- Jonathan R Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Hospital, Grafton, Auckland, New Zealand.
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Rodgers JE, Stough WG. Underutilization of Evidence-Based Therapies in Heart Failure: The Pharmacist's Role. Pharmacotherapy 2007; 27:18S-28S. [PMID: 17381371 DOI: 10.1592/phco.27.4part2.18s] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Utilization of evidence-based therapy in the heart failure population includes implementation of heart failure treatment guidelines, interventions to improve prescribing, and inclusion of pharmacists on the multidisciplinary team. Use of treatment guidelines eases the challenge of selecting the appropriate drug and dosage; quality interventions by pharmacists can ensure optimal prescribing of therapy; and provision of care by a multidisciplinary team can improve outcomes in patients with heart failure. Evidence-based therapy, however, remains underutilized in the heart failure population. Barriers to utilization include misperceptions that various heart failure subpopulations do not need certain medical therapies, a fear of polypharmacy, inappropriate assumptions about adverse effects and contraindications, and cost. In fact, optimal prescribing of evidence-based therapy can actually reduce costs. Clearly documented processes and systems are needed to ensure that evidence-based therapy and education are available to every patient.
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Affiliation(s)
- Jo Ellen Rodgers
- School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Vento M, Tudela BF, Escrig R, Sáenz P, Sánchez A, Cano A. Haemolysis alters plasma flecainide levels in newborn infants. Acta Paediatr 2007; 96:466-8. [PMID: 17407483 DOI: 10.1111/j.1651-2227.2007.00132.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Refractory neonatal supra-ventricular tachycardia may require the use of flecainide as anti-arrhythmic. Close control of plasma levels is mandatory due to pro-arrhythmic complications. However, inadvertent hemolysis during blood sampling may cause an increase in measured plasma flecainide concentrations. We conclude, therefore, that dosing of the drug should be always done with caution, and in case of suspected haemolysis plasma levels should be repeated with a new blood sample.
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Affiliation(s)
- M Vento
- Division of Neonatology, Hospital Materno-Infantil La Fe, Valencia, Spain.
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Narayan G, Akhtar M, Sra J. Combined use of 1C and III agents for highly symptomatic, refractory atrial fibrillation. J Interv Card Electrophysiol 2006; 15:175-8. [PMID: 16917731 DOI: 10.1007/s10840-006-9002-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 04/16/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite advances in non-pharmacologic therapy for atrial fibrillation (AF), some patients remain highly refractory. OBJECTIVE We report our experience with the unique combined use of 1C and III agents in patients with highly refractory paroxysmal atrial fibrillation. MATERIALS AND METHODS Six patients with symptomatic AF (three persistent) were selected after failing multiple antiarrhythmic medications and radiofrequency ablation. They were started on flecainide or propafenone and sotalol or dofetilide during three days of inpatient monitoring. No patient had coronary artery disease. All patients had loop recorder follow-up and ECG recordings during clinic visits for a mean follow-up of 9 +/- 11 months. RESULTS After therapy, all patients had complete, sustained control of their symptoms with no evidence of AF or proarrhythmia on monitoring. One patient had recurrence of AF after stopping sotalol and was started back on the drug with complete control. CONCLUSIONS Combined therapy with a 1C and III agent may be an effective alternative for the treatment of selective, highly refractory AF. Careful patient selection and hospitalization for initiation is necessary to minimize potential proarrhythmic effects. As this is a short-term therapy, further study is needed to assess the extent of efficacy in a larger number of patients.
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Affiliation(s)
- Girish Narayan
- Electrophysiology Laboratories, Aurora Sinai/St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health-Milwaukee Clinical Campus, Milwaukee, WI, USA
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Perles Z, Gavri S, Rein AJ. Tachyarrhythmias in the fetus: State of the art diagnosis and treatment. PROGRESS IN PEDIATRIC CARDIOLOGY 2006. [DOI: 10.1016/j.ppedcard.2006.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This review provides an updated framework for the diagnosis and management of neonatal tachycardias.
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Aiyagari R, Saarel EV, Etheridge SP, Bradley DJ, Dick M, Fischbach PS. Radiofrequency ablation for supraventricular tachycardia in children < or =15 kg is safe and effective. Pediatr Cardiol 2005; 26:622-6. [PMID: 16132307 DOI: 10.1007/s00246-004-0849-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Risks associated with radiofrequency ablation (RFA) have been reported to be increased in children < or =15 kg. We sought to compare the safety and efficacy of RFA in children <15 kg with those between 15.1 and 20 kg. Clinical, electrophysiologic, and RFA data for all patients < or =20 kg who underwent RFA for supraventricular tachycardia between January 1994 and January 2003 were reviewed. Patients were divided into those < or =15 kg (group 1, n = 25) and those between 15.1 and 20 kg (group 2, n = 44). The two groups differed significantly in age and weight by design (group 1: mean weight, 11.9 +/- 3.0 kg; age, 2.8 +/- 1.9 years; group 2: weight, 18.0 +/- 1.5 kg; age, 5.1 +/- 1.1 years). There were no significant differences in other baseline characteristics except for incidence of structural heart disease (28% group 1 vs 7% group 2, p < 0.01). No significant differences in mechanism of tachycardia, arrhythmia cycle length, number of total and brief RFA applications, total RFA time, average and maximum RFA temperatures, total procedure duration, short-term success rate (96% group 1 vs 86% group 2, p = 0.17), long-term success rate (91% group 1 vs 89% group 2, p = 0.76), or major complications (8.0% group 1 vs 2.3% group 2, p = 0.39) were found. There were no procedure-related deaths in either group. These data suggest that, in two large volume electrophysiology centers, the procedural risks and outcomes of RFA are similar between patients weighing less than 15 kg and those between 15.1 and 20 kg.
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Affiliation(s)
- R Aiyagari
- C.S. Mott Children's Hospital, University of Michigan Medical Center, 1500 E. Medical Center Drive, L1242 Women's 0204, Ann Arbor, MI 48109-0204, USA
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Redfearn DP, Krahn AD, Skanes AC, Yee R, Klein GJ. Use of medications in Wolff-Parkinson-White syndrome. Expert Opin Pharmacother 2005; 6:955-63. [PMID: 15952923 DOI: 10.1517/14656566.6.6.955] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The diagnosis of Wolff-Parkinson-White syndrome is generally straightforward; however, the management may not be, and requires an understanding of the competing risks of various treatment options and that of the clinical setting in which the diagnosis is made. The symptomatic patient with Wolff-Parkinson-White has an increased risk of atrial fibrillation and a small but significant risk of sudden cardiac death. Therapy is based on reduction in symptom burden and attenuation of the risk of pre-excited atrial fibrillation. Catheter ablation is the most effective means of achieving this goal with abolition of symptoms and risk of pre-excited atrial fibrillation. Medication is often employed in the acute setting to terminate paroxysms of arrhythmia associated with the accessory pathway and reduce the subsequent burden of symptoms until ablation can be performed. An overview of the agents commonly used is provided together with recommendations.
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Affiliation(s)
- D P Redfearn
- Division of Cardiology, University of Western Ontario, London, Ontario, Canada
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Yamreudeewong W, DeBisschop M, Martin LG, Lower DL. Potentially significant drug interactions of class III antiarrhythmic drugs. Drug Saf 2003; 26:421-38. [PMID: 12688833 DOI: 10.2165/00002018-200326060-00004] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Class III antiarrhythmic drugs, especially amiodarone (a broad-spectrum antiarrhythmic agent), have gained popularity for use in clinical practice in recent years. Other class III antiarrhythmic drugs include bretylium, dofetilide, ibutilide and sotalol. These agents are effective for the management of various types of cardiac arrhythmias both atrial and ventricular in origin. Class III antiarrhythmic drugs may interact with other drugs by two major processes: pharmacodynamic and pharmacokinetic interactions. The pharmacodynamic interaction occurs when the pharmacological effects of the object drug are stimulated or inhibited by the precipitant drug. Pharmacokinetic interactions can result from the interference of drug absorption, metabolism and/or elimination of the object drug by the precipitant drug. Among the class III antiarrhythmic drugs, amiodarone has been reported to be involved in a significant number of drug interactions. It is mainly metabolised by cytochrome P450 (CYP)3A4 and it is a potent inhibitor of CYP1A2, 2C9, 2D6 and 3A4. In addition, amiodarone may interact with other drugs (such as digoxin) via the inhibition of the P-glycoprotein membrane transporter system, a recently described pharmacokinetic mechanism of drug interactions. Bretylium is not metabolised; it is excreted unchanged in the urine. Therefore the interactions between bretylium and other drugs (including other antiarrhythmic drugs) is primarily through the pharmacodynamic mechanism. Dofetilide is metabolised by CYP3A4 and excreted by the renal cation transport system. Drugs that inhibit CYP3A4 (such as erythromycin) and/or the renal transport system (such as triamterene) may interact with dofetilide. It appears that the potential for pharmacokinetic interactions between ibutilide and other drugs is low. This is because ibutilide is not metabolised by CYP3A4 or CYP2D6. However, ibutilide may significantly interact with other drugs by a pharmacodynamic mechanism. Sotalol is primarily excreted unchanged in the urine. The potential for drug interactions due to hepatic enzyme induction or inhibition appears to be less likely. However, a number of drugs (such as digoxin) have been reported to interact with sotalol pharmacodynamically. If concurrent use of a class III antiarrhythmic agent and another drug cannot be avoided or no published studies for that particular drug interaction are available, caution should be exercised and close monitoring of the patient should be performed in order to avoid or minimise the risks associated with a possible adverse drug interaction.
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Affiliation(s)
- Weeranuj Yamreudeewong
- School of Pharmacy, University of Wyoming, and Pharmacy Services, Cheyenne VAMC, Cheyenne, Wyoming 82001, USA.
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