The Efficacy of Anti-Arrhythmic Drugs in Children With Idiopathic Frequent Symptomatic or Asymptomatic Premature Ventricular Complexes With or Without Asymptomatic Ventricular Tachycardia: a Retrospective Multi-Center Study

Abstract

The aim of the study is to compare the efficacy of flecainide, beta-blockers, sotalol, and verapamil in children with frequent PVCs, with or without asymptomatic VT. Frequent premature ventricular complexes (PVCs) and asymptomatic ventricular tachycardia (VT) in children with structurally normal hearts require anti-arrhythmic drug (AAD) therapy depending on the severity of symptoms or ventricular dysfunction; however, data on efficacy in children are scarce. Both symptomatic and asymptomatic children (≥ 1 year and < 18 years of age) with a PVC burden of 5% or more, with or without asymptomatic runs of VT, who had consecutive Holter recordings, were included in this retrospective multi-center study. The groups of patients receiving AAD therapy were compared to an untreated control group. A medication episode was defined as a timeframe in which the highest dosage at a fixed level of a single drug was used in a patient. A total of 35 children and 46 medication episodes were included, with an overall change in PVC burden on Holter of -4.4 percentage points, compared to -4.2 in the control group of 14 patients. The mean reduction in PVC burden was only significant in patients receiving flecainide (− 13.8 percentage points; N = 10; p = 0.032), compared to the control group and other groups receiving beta-blockers (− 1.7 percentage points; N = 18), sotalol (+ 1.0 percentage points; N = 7), or verapamil (− 3.9 percentage points; N = 11). The efficacy of anti-arrhythmic drug therapy on frequent PVCs or asymptomatic VTs in children is very limited. Only flecainide appears to be effective in lowering the PVC burden.

Pro‐arrhythmia with antiarrhythmic drugs in patients with idiopathic ventricular arrhythmia: A common problem with vague definitions and complex interactions

“…3 In the study, PVC burden response was categorized as "Good," "Poor," and "Proarrhythmic" and defined as 80% or more reduction of PVC burden (based on 1991 CAST trial), either less than 80% reduction or 50% or less increase of PVC burden and more than 50% increase of PVC burden with beta-blocker therapy compared with baseline PVC burden, respectively. 2 By using the same definition, we observe a "Good" and "Pro-arrhythmic" response in approximately 45%-50% and approximately 70%, and approximately 10% and approximately 3% of patients treated with propafenone and flecainide, respectively (unpublished data). Interestingly pro-arrhythmia with propafenone does not predict pro-arrhythmia with flecainide.…”

“…Pro-arrhythmia with antiarrhythmic drugs in patients with idiopathic ventricular arrhythmia: A common problem with vague definitions and complex interactions Beta-blockers, I c (flecainide/propafenone) antiarrhythmic drugs (AADs) or both are preferred first choice therapeutic options in patients with idiopathic ventricular arrhythmias (IVAs) with limited efficacy in both adult and pediatric populations. 1,2 Universally accepted, well-described definitions for therapeutic efficacy and pro-arrhythmia with AADs among patients with IVAs are lacking. Assessment of therapeutic efficacy solely based on symptoms can be misleading.…”

Effectiveness of beta-blockers in the treatment of idiopathic premature ventricular contractions in children

“…Так, в наиболее крупном ретроспективном исследовании детей с ЖТ (73 ребенка) было показано, что эффективность β-АБ и соталола составляет 35% и 62%, соответственно, тогда как пропафенон и флекаинид имели эффективность 65% [12]. Другие исследования, основанные на небольших группах детей с желудочковыми аритмиями, также подтверждают хорошую эффективность флекаинида [7,13]. Результаты использования β-АБ у детей с ЖЭС разнятся, есть данные о неплохой эффективности атенолола, но в большинстве случаев β-АБ не позволяют длительно и устойчиво контролировать желудочковую аритмию, хотя и назначаются чаще всего [7,13].…”

“…Другие исследования, основанные на небольших группах детей с желудочковыми аритмиями, также подтверждают хорошую эффективность флекаинида [7,13]. Результаты использования β-АБ у детей с ЖЭС разнятся, есть данные о неплохой эффективности атенолола, но в большинстве случаев β-АБ не позволяют длительно и устойчиво контролировать желудочковую аритмию, хотя и назначаются чаще всего [7,13].…”

Ventricular tachycardia ablation in children

“…The clinical features and prognoses of VTs depend on the type, the clinical category, age at onset, accurate diagnosis, and proper treatment [ 3 ]. Antiarrhythmic therapy in pediatric patients with ventricular arrhythmias is not significantly effective [ 4 ]. Catheter ablation is an approved and safe method to eliminate the different types of pediatric arrhythmias, including VTs [ 5 , 6 ].…”