Amiodarone Versus Procainamide for the Acute Treatment of Recurrent Supraventricular Tachycardia in Pediatric Patients

Abstract

Background-Intravenous amiodarone and procainamide are both used as therapies for refractory supraventricular tachycardia (SVT). However, no studies have compared the efficacy and safety of these agents in pediatric patients. Methods and Results-All patients treated with intravenous amiodarone or procainamide during 25 consecutive months for the following mechanisms of SVT were included: orthodromic reciprocating tachycardia, intra-atrial reentrant tachycardia, and ectopic atrial tachycardia; junctional ectopic tachycardia was excluded. Treatment response was categorized as full success, partial success, or failure. Partial success was defined as clinical improvement and/or arrhythmia control but not meeting full success criteria. Adverse events were classified as major (requiring resuscitation) or minor (management changes). There were 40 episodes of SVT in 37 patients (median age, 34 days; 24 with congenital heart disease). Amiodarone was the initial therapy in 26 cases and procainamide in 14 cases. If partial and full success are combined, procainamide was successful in 71% of cases compared with 34% for amiodarone (Pϭ0.046). If partial success is considered a treatment failure, procainamide was successful in 50% compared with 15% for amiodarone (Pϭ0.029). Ten patients received the second medication after the first failed. Success was achieved in 5 of 8 amiodarone-to-procainamide crossovers compared with 1 of 2 procainamide-to-amiodarone crossovers. One major and 10 minor adverse events occurred in amiodarone patients versus 6 minor adverse events in procainamide patients (PϭNS). Conclusions-In this cohort, procainamide achieved greater success compared with amiodarone in the management of recurrent SVT without statistically significant differences in adverse event frequency. (Circ Arrhythm Electrophysiol.

Is It Time to Tell the Emperor He Has No Clothes?

“…However, the data reviewed above support the conclusions reached by Chang et al: amiodarone may be less effective and procainamide more effective than many pediatric cardiac intensivists and electrophysiologists believe. The randomized study of amiodarone also indicated a much higher incidence of hypotension than previously recognized, and procainamide appears to be very safe in the pediatric population, both consistent with the study by Chang et al 1 One interesting point is that although the Chang et al study, as well as our own, finds that intravenous amiodarone is the more utilized drug in the setting of acute refractory SVAs, this may not be the case universally. A 2006 survey 17 of US and Canadian pediatric cardiologists queried the practitioner's treatment of a hypothetical infant with adenosine refractory SVT.…”

“…2 Most have reported high efficacy and low side effects, again most consistently for JET. In 2005, the results of a "large" (nϭ61) randomized, double-blind, dose-response study (1,5, and 10 mg/kg) were published, 3 demonstrating that there was a significant difference in time to success for the 3 dose groups, including SVA, JET, and VA (Pϭ0.028). However, when the 31 JET and 26 SVA patients were analyzed separately, the results were not significant (Pϭ0.10 and Pϭ0.29, respectively) (Figure).…”

2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia

“…The risk of SCD associated with WPW appears highest in the first 2 decades of life. [254][255][256][257][258] Antiarrhythmic drug treatment of patients with orthodromic AVRT can be directed at either the accessory pathway or the AV node, as both are key portions of the reentrant circuit. AV nodal-blocking agents may be contraindicated in patients at risk of rapid conduction down the accessory pathway during AF.…”

AV nodal reentrant tachycardia or AV reentrant tachycardia using a concealed bypass tract-related adverse events

“…The role of drugs as a cause of adverse event has indeed been previously reported by several authors. Chang [11] reported one major adverse event that occurred in a procainamide-toamiodarone crossover patient who had profound bradycardia and hypotension after receiving a large amiodarone dose. There was also 1 death in a patient receiving amiodarone, although this was attributed to sepsis and progressive deterioration of the patient's primary cardiac disease.…”