Background: Carvedilol reduces mortality and hospitalization in adults with congestive heart failure. Limited information is available about its use in children. Methods:We reviewed the medical records of 24 children with dilated cardiomyopathy and left ventricular ejection fraction of Յ40%, who were treated with carvedilol as adjunct therapy to angiotensinconverting enzyme inhibitors, digoxin and diuretics. Results:Carvedilol was initiated 14.3 Ϯ 23.3 (mean Ϯ SD) months after the diagnosis of cardiomyopathy. Mean age at initiation of therapy was 7.2 Ϯ 6.4 years. The mean initial and maximum doses were 0.15 Ϯ 0.09 and 0.98 Ϯ 0.26 mg/kg/day. Adverse effects occurred in 5 patients (21%). Two patients (8%) required discontinuation of the drug within 5 weeks of the initial dose. The remaining 22 patients tolerated carvedilol for a mean follow-up period of 26.6 Ϯ 14.7 months. Among these 22 patients, mean left ventricular ejection fraction improved from 24.6 Ϯ 7.6% to 42.2 Ϯ 14.2% (p Ͻ 0.001), and mean sphericity index from 0.86 Ϯ 0.11 to 0.74 Ϯ 0.10 (p Ͻ 0.001). New York Heart Association functional class improved in 15 patients (68%). One patient (4%) died and 3 (14%) were transplanted. Conclusions: Carvedilol, in addition to standard therapy for dilated cardiomyopathy in children improves cardiac function and symptoms; it is well tolerated, with minimal adverse effects, but close monitoring is necessary as it might worsen congestive heart failure and precipitate asthma. Control studies are necessary to assess the effect of carvedilol on mortality and hospitalization rates.

Atrioventricular reentrant tachycardia (AVRT) is the most common cause of supraventricular tachycardia in young children. In nearly 70% of cases, there is manifest preexcitation on electrocardiogram. In the rest, the accessory pathway is concealed. Drugs control AVRT by affecting conduction through the atrioventricular node (beta-blockers, digoxin, verapamil) or accessory pathway (flecainide, propafenone) or both (sotalol, amiodarone). Adenosine is the drug of choice in acute management of AVRT in hemodynamically stable children. In adenosine-resistant cases, intravenous flecainide, procainamide, esmolol, propafenone and amiodarone are other treatment options. Hypotension and bradycardia can occur during administration of these drugs. Verapamil may be used to treat AVRT using a concealed pathway. Verapamil should be avoided in infants and in patients with decreased cardiac function. In chronic management, catheter ablation is the preferred treatment in older children with frequent AVRT. In infants and small children, ablation is associated with higher risk, and pharmacologic management is recommended. Beta-blockers are the preferred first line drugs for chronic management. In patients with concealed accessory pathway, digoxin and calcium channel blockers are alternative options. Sotalol, flecainide, propafenone and amiodarone can be prescribed in resistant cases. Flecainide and propafenone should be avoided in children with structurally abnormal hearts because of a higher risk of proarrhythmia. The initiation of flecainide, propafenone and sotalol therapy is recommended in an inpatient setting to monitor for proarrhythmias.

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