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Pereyra RB, Gonzalez Vidal NL. Amiodarone chewable gels as a potential appproach for paediatric congenital cardiopathies treatment: Comparison between animal and vegetal gelling agents. Eur J Pharm Biopharm 2024:114370. [PMID: 38880402 DOI: 10.1016/j.ejpb.2024.114370] [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: 03/21/2024] [Revised: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 06/18/2024]
Abstract
The difficulty in swallowing is a frequent problem when oral solid dosage forms (conventional tablets or capsules) are administered to paediatric population or patients with dysphagia. An interesting alternative to overcome these problems are non-conventional formulations like chewable gels, commonly known as 'gummies'. Therefore, this work addresses the design, development and characterization of gummies using gelatine and pectin, for the vehiculization of the antiarrhythmic amiodarone (AMIO). Applying a Design of Experiments (DoE) approach, four gelatine (GG1-GG4) and eight pectin formulations (PG1-PG8) were developed. Considering the obtained results for responses during DoE evaluation (i.e., volume, syneresis, hardness, and gumminess), GG3 and PG8 were selected for complete characterization. Water activity, pH, drug content, texture parameters (adhesiveness, springiness, cohesiveness, and fracturability), disintegration time, in vitro dissolution, and microbiological features were evaluated. The obtained results were within the expected values for this type of formulation. The dissolution profiles showed a 94 % - 99 % of the AMIO content released for GG3 and PG8, respectively, so they could be considered suitable as immediate release dosage forms. In conclusion, the chewable gels were successfully developed and characterised, suggesting a potential means to accomplish a final prototype for the improvement of congenital cardiopathies treatment.
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Affiliation(s)
- Romina B Pereyra
- Departamento de Biología, Bioquímica y Farmacia - Universidad Nacional del Sur (UNS), Bahía Blanca, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bahía Blanca, Buenos Aires, Argentina
| | - Noelia L Gonzalez Vidal
- Departamento de Biología, Bioquímica y Farmacia - Universidad Nacional del Sur (UNS), Bahía Blanca, Buenos Aires, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Bahía Blanca, Buenos Aires, Argentina.
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Batra AS, Silka MJ, Borquez A, Cuneo B, Dechert B, Jaeggi E, Kannankeril PJ, Tabulov C, Tisdale JE, Wolfe D. Pharmacological Management of Cardiac Arrhythmias in the Fetal and Neonatal Periods: A Scientific Statement From the American Heart Association: Endorsed by the Pediatric & Congenital Electrophysiology Society (PACES). Circulation 2024; 149:e937-e952. [PMID: 38314551 DOI: 10.1161/cir.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Disorders of the cardiac rhythm may occur in both the fetus and neonate. Because of the immature myocardium, the hemodynamic consequences of either bradyarrhythmias or tachyarrhythmias may be far more significant than in mature physiological states. Treatment options are limited in the fetus and neonate because of limited vascular access, patient size, and the significant risk/benefit ratio of any intervention. In addition, exposure of the fetus or neonate to either persistent arrhythmias or antiarrhythmic medications may have yet-to-be-determined long-term developmental consequences. This scientific statement discusses the mechanism of arrhythmias, pharmacological treatment options, and distinct aspects of pharmacokinetics for the fetus and neonate. From the available current data, subjects of apparent consistency/consensus are presented, as well as future directions for research in terms of aspects of care for which evidence has not been established.
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Leoni L, Bronzetti G, Colonna D, Porcedda G, Rimini A, Silvetti MS. Diagnosis and treatment of fetal and pediatric age patients (0-12 years) with Wolff-Parkinson-White syndrome and atrioventricular accessory pathways. J Cardiovasc Med (Hagerstown) 2023; 24:589-601. [PMID: 37409656 PMCID: PMC10836786 DOI: 10.2459/jcm.0000000000001484] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/16/2023] [Indexed: 07/07/2023]
Abstract
Overt or concealed accessory pathways are the anatomic substrates of ventricular preexcitation (VP), Wolff-Parkinson-White syndrome (WPW) and paroxysmal supraventricular tachycardia (PSVT). These arrhythmias are commonly observed in pediatric age. PSVT may occur at any age, from fetus to adulthood, and its symptoms range from none to syncope or heart failure. VP too can range from no symptoms to sudden cardiac death. Therefore, these arrhythmias frequently need risk stratification, electrophysiologic study, drug or ablation treatment. In this review of the literature, recommendations are given for diagnosis and treatment of fetal and pediatric age (≤12 years) WPW, VP, PSVT, and criteria for sport participation.
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Affiliation(s)
- Loira Leoni
- Cardiology, Department of Cardio-Thoracic-Vascular Sciences and Public Health, University Hospital of Padua, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart), Padua
| | - Gabriele Bronzetti
- Cardio-Thoraco-Vascular Department, Sant’Orsola Hospital, University Hospital of Bologna IRCCS, Bologna
| | - Diego Colonna
- Adult Congenital Heart Disease Unit, Monaldi Hospital, Naples
| | - Giulio Porcedda
- Unit of Pediatric Cardiology, Anna Meyer Children's Hospital, Florence
| | | | - Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmia/Syncope Unit, and Bambino Gesù Children's Hospital, IRCCS, European Reference Network for Rare and Low Prevalence Complex Disease of the Heart (ERN GUARD-Heart). Rome, Italy
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Oeffl N, Schober L, Faudon P, Schweintzger S, Manninger M, Köstenberger M, Sallmon H, Scherr D, Kurath-Koller S. Antiarrhythmic Drug Dosing in Children-Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050847. [PMID: 37238395 DOI: 10.3390/children10050847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Antiarrhythmic drugs represent a mainstay of pediatric arrhythmia treatment. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential uncertainties and even mistakes with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.
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Affiliation(s)
- Nathalie Oeffl
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Lukas Schober
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Patrick Faudon
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Sabrina Schweintzger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Martin Manninger
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Martin Köstenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Hannes Sallmon
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Stefan Kurath-Koller
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, 8036 Graz, Austria
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Muacevic A, Adler JR, Hassan Hakami NM, Masmali OE. Treating Supraventricular Tachycardia With Amiodarone in a Patient With Ebstein's Anomaly. Cureus 2023; 15:e33772. [PMID: 36793847 PMCID: PMC9925042 DOI: 10.7759/cureus.33772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2023] [Indexed: 01/15/2023] Open
Abstract
Ebstein's anomaly is a congenital deformity marked by disease of the tricuspid valve and right cardiac hypertrophy. The severity, morphology, and appearance of Ebstein's anomaly cases might vary greatly. We discuss a case of an eight-year-old child with Ebstein's anomaly who presented with supraventricular tachycardia and was effectively treated with amiodarone after initial treatment with adenosine failed to reduce the heart rate.
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Marx M, Gass M, Michel-Behnke I. Generationenübergreifende Betreuung von Patienten mit tachykarden Rhythmusstörungen. Monatsschr Kinderheilkd 2022; 170:870-882. [PMID: 36105264 PMCID: PMC9461413 DOI: 10.1007/s00112-022-01591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
Die Versorgung von Patienten mit Rhythmusstörungen hat sich in den letzten Jahrzehnten von einer rein konservativ medikamentösen Therapie zu einer echten kurativen Therapie mit Beseitigung des arryhthmogenen Substrats durch technisch immer ausgereiftere Möglichkeiten im Sinn der elektrophysiologische Untersuchung (EPU) und Ablation entwickelt. Parallel dazu haben sich in pädiatrisch-kardiologischen Zentren rhythmologische Spezialambulanzen zur Betreuung von Patienten mit Ionenkanalerkrankungen etabliert. Deren Aufgabe besteht in der generationenübergreifenden Betreuung von ganzen Familien, mit dem Ziel, präventiv, durch entsprechende Beratung und Führung, maligne Rhythmusstörungen primär zu verhindern.
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Affiliation(s)
- Manfred Marx
- Klinische Abteilung für Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Matthias Gass
- Klinische Abteilung für Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Pädiatrische Kardiologie, Universitäts-Kinderklinik Zürich, Zürich, Schweiz
| | - Ina Michel-Behnke
- Klinische Abteilung für Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
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Escudero CA, Tan RBM, Beach CM, Dalal AS, LaPage MJ, Hill AC. Approach to Wide Complex Tachycardia in Paediatric Patients. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:60-73. [PMID: 37969244 PMCID: PMC10642107 DOI: 10.1016/j.cjcpc.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2023]
Abstract
Wide complex tachycardia (WCT) is an infrequently encountered condition in paediatric patients and may be due to a variety of causes including supraventricular tachycardia with aberrant conduction, ventricular activation via an accessory pathway, ventricular pacing, or ventricular tachycardia. Immediate tachycardia termination is required in haemodynamically unstable patients. After stabilization or in those with haemodynamically tolerated WCT, a careful review of electrocardiographic tracings and diagnostic manoeuvres are essential to help elucidate the cause. Subacute and chronic management for WCT will depend on the underlying cause as well as features of the patient and the tachycardia presentation. This article will review the epidemiology, potential causes, and management of WCT in children. A detailed review of the pathophysiology, differential diagnosis, and diagnostic and treatment options is provided to enable the reader to develop a practical approach to managing this condition in young patients.
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Affiliation(s)
- Carolina A. Escudero
- Division of Cardiology, Department of Pediatrics, University of Alberta and Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Reina Bianca M. Tan
- Division of Cardiology, Department of Pediatrics, NYU Langone Health and Hassenfeld Children’s Hospital, New York, New York, USA
| | - Cheyenne M. Beach
- Section of Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Aarti S. Dalal
- Division of Cardiology, Department of Pediatrics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee, USA
| | - Martin J. LaPage
- Division of Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Allison C. Hill
- Division of Cardiology, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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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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