Long-term efficacy and safety of atenolol for supraventricular tachycardia in children

Abstract

Propranolol, a first-generation nonselective beta-adrenoceptor blocking agent, is commonly used to treat pediatric arrhythmias. Atenolol, relatively long-acting, cardioselective beta-adrenoceptor blocking agent, has been successfully used in adults with supraventricular tachycardia (SVT). There is only one report on the use of atenolol in children with SVT; and our report is on the first long-term prospective study to evaluate the use of atenolol in children. A group of 22 children < 18 years of age with clinical SVT were enrolled in the study. The tachycardia was documented on electrocardiograms in each case and was confirmed by electrophysiologic studies in some. Once-a-day oral atenolol was started as a monotherapy. Of the 22 children with various types of SVT, 13 (59%) were well controlled on long-term oral atenolol therapy. The effective dose of atenolol ranged between 0.3 and 1.3 mg/kg/day (median effective dose 0.7 mg/kg/day). Five children had some adverse effects. However, none in the successful group of 13 patients required drug discontinuation because of such effects. Once-a-day oral atenolol as a monotherapy is effective and relatively safe for long-term management of SVT during childhood. It is an attractive alternative beta-adrenoceptor blocking agent for the management of pediatric arrhythmias.

Comparing the Effectiveness of Propranolol versus Atenolol in Inducing Clinical Clearance in the Treatment of Infantile Haemangioma

“…Atenolol has been safely used in infants for cardiological indications, such as supraventricular tachycardia without significant adverse effects. [ 22 ]…”

Atenolol Pharmacokinetics and Excretion in Breast Milk During the First 6 to 8 Months Postpartum

“…Only 1 child younger than 1 year of age participated in the study (a 6‐week‐old infant) and received 2000 μg/kg/d, but the atenolol was discontinued for recurrent tachycardia. Two other children who were less than 2 years of age participated in the study, and both were successfully treated with atenolol (800 and 1100 μg/kg/d) 18 . Accordingly, the recommended oral initial antiarrhythmic dose of atenolol in children ranges from 300 to 1000 μg/kg/d 17 – 19 .…”

JCS/JHRS 2020 Guideline on Pharmacotherapy of Cardiac Arrhythmias

“…The monotherapy with atenolol was reported to be effective in 59% of adolescents with AVNRT. 906 The combination of β-blocker and Class IC drug was preferred in patients without sufficient suppression of AV nodal conduction and no structural heart disease. 836 ▋ 1.3.2 Accessory Pathway-Mediated Tachycardias (Table 70) Pre-excitation syndrome can cause AVRT via accessory pathway, rapid ventricular conduction via antegrade accessory pathway with atrial fibrillation (AF), 907 and decreased ventricular function associated with ventricular dyssynchronous contractions.…”