Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia

Arvind, Balaji; Ss, Kothari; Juneja, Rajnish; Saxena, Anitá; Ramakrishnan, Sivasubramanian; Gupta, Saurabh Kumar; Chowdhury, Ujjwal K.; Devagourou, Velayoudam; Talwar, Sachin; Hote, Milind Padmakar; Rajashekar, Palleti; Sahu, Manoj Kumar; Singh, Sarvesh Pal

doi:10.1016/j.jacep.2021.01.020

Cited by 19 publications

(30 citation statements)

References 27 publications

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“…On the other hand, amiodarone and ivabradine have different pharmacokinetic and dynamic properties. Ivabradine has previously been used concomitantly with amiodarone to treat junctional ectopic tachycardia at doses 0.02 to 0.1 mg/kg/day with rarely reported severe adverse effects [4,14]. In small children, precautions are needed when preparing the drug.…”

Section: Discussionmentioning

confidence: 99%

“…Ivabradine is currently indicated in the treatment of heart failure and angina in adults, and in heart failure and dilated cardiomyopathy in children [2,3]. Recently, ivabradine has also been used in treating automatic tachycardias such as ectopic atrial tachycardia and junctional ectopic tachycardia [4,5]. Ivabradine's cardiac adverse effects include atrial fibrillation, sinus node dysfunction, atrioventricular block, and bundle branch block [1].…”

Section: Introductionmentioning

confidence: 99%

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Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

et al. 2022

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Ivabradine is currently approved to reduce heart rate in children with chronic heart failure and dilated cardiomyopathy. Ivabradine has also been used off-label in children to treat automatic tachyarrhythmias such as ectopic atrial tachycardia and junctional ectopic tachycardia. Adverse effects of ivabradine at physiological doses as well as its toxicity at supra-physiological doses have rarely been reported in adults. In children, weight-based dosing requires dilution of commercially available ivabradine oral solution for accuracy. We describe a case of ivabradine overdose in a newborn (treated for ectopic atrial tachycardia) secondary to inaccurate dosing leading to the infant receiving 10 times more drug than prescribed. This case highlights potential pitfalls of ivabradine prescription and preparation in children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

et al. 2022

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“…Several retrospective reports have demonstrated successful conversion of postoperative JET using ivabradine as an adjunctive therapy 6–8. Moreover, a randomised trial has shown the non-inferiority of ivabradine to amiodarone as a prior monotherapy for managing postoperative JET in children, establishing the usefulness of ivabradine in this context 9. Additionally, ivabradine has a relatively haemodynamically neutral profile compared with many alternative antiarrhythmic agents, as evidenced by cohort and randomised, double-blind, placebo-controlled trials in children with dilated cardiomyopathy, which showed the safety of oral ivabradine therapy without adverse effects 10.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment with ivabradine for haemodynamically unstable junctional ectopic tachycardia occurring early after ST-elevation myocardial infarction

Numao,

Otsuka,

Nuki

et al. 2024

BMJ Case Rep

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Junctional ectopic tachycardia (JET) is a relatively uncommon arrhythmia predominantly observed in infancy, often occurring after congenital heart surgery. Although JET is rare in adults, it can occur in the presence of myocardial ischaemia. We describe a woman in her early 70s who presented with multivessel ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention on left anterior descending artery and right coronary artery. She developed JET on the second day, resulting in haemodynamic compromise. Despite initial treatment attempts including amiodarone and beta-blocking agents proving insufficient in controlling JET, we successfully managed by administering ivabradine. Subsequently, she was discharged with recovered cardiac function without recurrence of JET. JET often proves refractory to multiple antiarrhythmic agents and can lead to unfavourable outcomes. Several case reports have demonstrated the effectiveness of ivabradine in treating JET during infancy, which can also be an effective therapeutic option for adult without adversely affecting haemodynamics.

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“…21,24,25 The efficacy of amiodarone, a class III antiarrhythmic drug, and ivabradine, an If channel inhibitor, for the treatment of JET after surgery for CHD has been reported. 28 However, ivabradine is an oral medication, which may not be suitable for the acute control of tachycardia or in postsurgical situations. Amiodarone is characterized by slow clearance (90-158 mL/h/kg) and long terminal elimination half-life (20-47 days).…”

Section: Discussionmentioning

confidence: 99%

Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL)　― Results of a Prospective, Multicenter, Uncontrolled Clinical Study ―

Sagawa

Suzuki

Takei

et al. 2022

Circ J

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macological therapy, non-pharmacological treatments, such as catheter ablation or implantation of a cardioverter defibrillator, are an option for adult patients. 3,4 However, non-pharmacological approaches are sometimes difficult in some types of CHD, or after surgical procedures for anatomical reasons in children. 2,5 Amiodarone and nifeka-V arious tachyarrhythmias may occur after surgical repair of congenital heart disease (CHD) and they may be potentially fatal. 1,2 Following onset, emergency therapy to control and terminate the tachycardia, and to prevent circulatory deteriorations, is usually mandatory. In patients with tachyarrhythmia resistant to phar-

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Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia

Cited by 19 publications

References 27 publications

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

Successful treatment with ivabradine for haemodynamically unstable junctional ectopic tachycardia occurring early after ST-elevation myocardial infarction

Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL)　― Results of a Prospective, Multicenter, Uncontrolled Clinical Study ―

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Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia

Cited by 19 publications

References 27 publications

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

Ivabradine Overdose in a Newborn: Precautions of Dispensing in Infants

Successful treatment with ivabradine for haemodynamically unstable junctional ectopic tachycardia occurring early after ST-elevation myocardial infarction

Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL) ― Results of a Prospective, Multicenter, Uncontrolled Clinical Study ―

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Product

Resources

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Control of Heart Rate in Infant and Child Tachyarrhythmia With Reduced Cardiac Function Using Landiolol (HEARTFUL)　― Results of a Prospective, Multicenter, Uncontrolled Clinical Study ―