Probable Association of Tachyarrhythmia With Nebulized Albuterol in a Child With Previously Subclinical Wolff Parkinson White Syndrome

Abstract

We present the case of a 2-year-old asthmatic boy with atrioventricular (AV)-reentry tachycardia following albuterol inhalation, who was later diagnosed with Wolff-Parkinson-White (WPW) syndrome. The Naranjo adverse drug reaction probability scale score for this adverse event was 7, indicating that the association between his AV-reentry tachycardia and inhalation of albuterol is probable. To our knowledge, this is the first case report that shows the potential arrhythmogenic effects of albuterol in a child with WPW syndrome. We urge clinicians to be aware of this potentially life-threatening adverse effect and to closely monitor these patients when they need beta-adrenergic drugs in case of emergency. Furthermore, this report highlights the dilemma regarding the safe treatment of pediatric patients with both asthma and WPW syndrome.

Inhaled Short-Acting Beta Agonist Treatment-Associated Supraventricular Tachycardia in Children: Still a Matter of Concern in Pediatric Emergency Departments?

“…Six databases were used: Medline, Embase, Cochrane Central, PubMed, Web of Knowledge, and International Pharmaceutical Abstracts. We retrieved five manuscripts [ 15 , 16 , 17 , 18 , 19 ], which described eleven cases in children aged 19 months [ 16 ] to 8 years [ 17 ] with seven males. Seven of the eleven cases were reported in a single-center hospital-based study that estimated an SVT incidence of 3.9 per 10,000 episodes in SABA treatment and 5.1 per 10,000 asthmatic children treated at a hospital [ 19 ].…”

Asymptomatic Wolff-Parkinson-White Syndrome (WPW)

“…1 The incidence is reported to be 0.9%-3% of the general population and most diagnoses are made on routine EKGs. 2,3 WPW is thought to be caused by abnormalities of conduction through the accessory pathway, also known as the Bundle of Kent, causing premature excitation of the ventricles. The complications from WPW are supraventricular tachycardia, atrial arrhythmias, and ventricular fibrillation leading to sudden cardiac death.…”

Evaluation of left atrial and left ventricular functions in patients with Wolff‐Parkinson‐White syndrome before and after radiofrequency catheter ablation using three‐dimensional speckle tracking echocardiography

“…Wolff‐Parkinson‐White (WPW) syndrome is one of the most common congenital cardiac abnormalities among ventricular pre‐excitation syndromes, with a prevalence of .9%–3% in the general population. It is characterized by a short PR interval, a wide QRS duration (> 120 ms), and a delta wave with or without secondary ST‐T change on the electrocardiogram 1,2 . Anterograde and retrograde electrophysiologic properties of the accessory pathways (APs) have been well investigated.…”

“…It is characterized by a short PR interval, a wide QRS duration (> 120 ms), and a delta wave with or without secondary ST-T change on the electrocardiogram. 1,2 Anterograde and retrograde electrophysiologic properties of the accessory pathways (APs) have been well investigated. The presence of AP is electrocardiographically manifested by a delta wave just before QRS initiation, leading to a short atrioventricular delay due to its uninhibited electrical conduction, and eventually to asynchronous contraction resulting in left ventricular (LV) dysfunction.…”