Pharmacological Therapy in Children with Nodal Reentry Tachycardia: When, How and How Long to Treat the Affected Patients

Bouhouch, R.; Houari, Tarik El; Fellat, Ibtissam; Arharbi, M.

doi:10.2174/138161208784007716

Cited by 8 publications

(3 citation statements)

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“…Adenosine is used more frequently because it is the safest and most effective medication in the acute context, but according to a review of the literature on the use of antiarrhythmic medications for the management of AVNRT in children older than 1 year, digoxin is still the medication of choice [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Digoxin for the Management of Unstable Paroxysmal Supraventricular Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural Hospital

Kassa,

Amede,

Wubante

et al. 2023

Case Reports in Emergency Medicine

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Background. The most frequent atrioventricular tachycardia in the emergency room is atrioventricular nodal reentrant tachycardia (AVNRT). The first treatment option for ending stable narrow QRS complex SVTs is vagal maneuvers and adenosine. When adenosine or vagal maneuvers fail to change a patient’s rhythm to normal sinus rhythm, long-acting AV nodal-blocking medications, including nondihydropyridine calcium channel blockers (verapamil and diltiazem), flecainide, or beta-blockers, are employed. Electricity (synchronized cardioversion) is the preferred form of treatment for unstable patients. Case Presentation. A 40-year-old male patient presented to the Emergency Department of Dubti General Hospital, the Afar regional state in Ethiopia, with a complaint of shortness of breath, palpitation, extreme fatigue, and chest pain of a day’s duration. His blood pressure was 80/50 mmHg, he had cold extremities and a weak radial pulse, and his apical heart rate was fast, making it difficult to count. His electrocardiogram (ECG) showed paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 200. He was a candidate for electrical cardioversion due to unstable PSVT, but he and his family members refused to give consent. Even though he is not indicated for pharmacologic therapy, none of the commonly used drugs were available at the hospital. We managed him with digoxin, and the outcome was positive. Conclusion. Even though we could not find a clear recommendation regarding the use of digoxin for patients with unstable PSVT (AVNRT), by taking into consideration its negative chronotropic effect and its action to suppress the AV nodal conduction velocity, it may reduce the heart rate, and it can be used as an alternative in such difficult scenarios and a resource-limited setting. But this should be further investigated.

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Section: Discussionmentioning

confidence: 99%

Digoxin for the Management of Unstable Paroxysmal Supraventricular Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural Hospital

Kassa,

Amede,

Wubante

et al. 2023

Case Reports in Emergency Medicine

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“…Flecainide is frequently used for treatment of supraventricular arrhythmias in children and has for the most part been proven to be safe and effective [1,4,6]. Due to findings of the CAST study in 1991, demonstrating increased mortality in adults after myocardial infarction, many pediatric clinicians were deterred from using flecainide in children with structurally abnormal hearts or CM [2,6].…”

Section: Discussionmentioning

confidence: 99%

“…Since its introduction over 20 years ago, flecainide acetate has been an important part of this armamentarium. It is frequently used for treatment of supraventricular tachycardia (SVT) in children and has for the most part been proven to be safe and effective [1,4,6]. In recent years, it has also arisen as a potential target in treatment of catecholaminergic polymorphic ventricular tachycardia [8].…”

Section: Introductionmentioning

confidence: 99%

Flecainide Use in Children with Cardiomyopathy or Structural Heart Disease

et al. 2014

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Flecainide is frequently used for treatment of cardiac arrhythmias in children. Due to concerns regarding increased mortality, there has been hesitancy to use flecainide in children with congenital heart disease (CHD) or cardiomyopathy (CM). The objective of this study was to describe trends in use of flecainide in children with CHD or CM and assess its association with cardiac arrest or death. Data from 42 children's hospitals contained in the PHIS database (2004-2011) were analyzed. All patients with CHD or CM receiving anti-arrhythmic therapy for supraventricular arrhythmias were reviewed. Trends in flecainide use were analyzed, and the incidence of cardiac arrest or death was compared to patients receiving other anti-arrhythmics. There were 3,544 pts with CHD or CM who received anti-arrhythmic therapy (median age 73 days). Flecainide was administered in 229 pts (6.5%). There was a trend toward increased use of flecainide in this population, increasing from 4.6% in 2004 to 8.7% in 2011 (p = 0.07). The incidence of cardiac arrest in patients with CHD or CM receiving flecainide was 3.0% with an overall mortality of 4.3%. The mortality was 2.9% in pts with CM and nobody with single ventricle physiology died. Based on multivariable analysis, when compared to pts with CHD or CM receiving other anti-arrhythmics, there was no difference in the incidence of cardiac arrest (p = 0.31) or death (p = 0.28). Flecainide use in children with CHD or CM has increased in recent years. The incidence of cardiac arrest or death with flecainide administration in this cohort appears comparable to other anti-arrhythmic agents.

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Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients

et al. 2015

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Cardiac arrhythmias occurring during the intraoperative period for cardiac surgery have been associated with excess morbidity and mortality. Several antiarrhythmics have been utilized for the management of intraoperative arrhythmias. These antiarrhythmic medications can cause undesirable adverse outcomes in the intensive care setting. The incidence and treatment of adult intraoperative arrhythmias have been studied. In addition, the prevalence, risk factors, and optimal treatment of pediatric postoperative arrhythmias have also been studied. However, the literature has not been published on intraoperative antiarrhythmia treatment during pediatric cardiac surgery. The purpose of this study was to determine the safety of intraoperative antiarrhythmic medications utilized in pediatric cardiac surgery patients. This was a retrospective review of all patients who received an intraoperative antiarrhythmic in the cardiovascular operating room at Texas Children's Hospital. Patients were included if they underwent cardiovascular surgery from November 2008 to July 2013 and were excluded if antiarrhythmics were given intraoperatively for other indications (i.e., esmolol for hypertension) or if patients were older than 18 years of age. Safety of antiarrhythmic treatment was determined by the absence or presence of adverse events. Control or recurrence of the arrhythmia was analyzed as a secondary measure to help determine antiarrhythmic efficacy. A total of 45 patients were identified (53.3 % male). Patients were a median of 0.52 years at the time of surgery. Primary surgery types were tetralogy of Fallot repair (n = 6; 13.3 %) and ventricular septal defect closure (n = 5, 11.1 %). Thirty-one patients (68.9 %) had documented adverse events after the administration of antiarrhythmics. Most of these adverse events occurred after the administration of amiodarone (n = 16; 51.6 %) followed by esmolol (n = 15; 48.4 %). Fifty-one percent of the arrhythmias resolved in the operating room (n = 23), and nearly half (n = 19) of all patients were discharged home on an antiarrhythmic medication. A high incidence of adverse events was associated with intraoperative administration of antiarrhythmic medications.

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Pharmacological Therapy in Children with Nodal Reentry Tachycardia: When, How and How Long to Treat the Affected Patients

Cited by 8 publications

References 0 publications

Digoxin for the Management of Unstable Paroxysmal Supraventricular Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural Hospital

Digoxin for the Management of Unstable Paroxysmal Supraventricular Tachycardia in a Patient Who Refused Electrical Cardioversion in a Rural Hospital

Flecainide Use in Children with Cardiomyopathy or Structural Heart Disease

Evaluating the Safety of Intraoperative Antiarrhythmics in Pediatric Cardiac Surgery Patients

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