Ectopic Atrial Tachycardia in a 12-Month-Old Girl Treated With Ivabradine and Beta-Blocker, a Case Report

Abstract

We report on a 12-month-old girl with an ectopic atrial tachycardia successfully treated with the combination of a beta blocking agent and Ivabradine that acts on cardiac pacemaker cells by selectively inhibiting the I f channel. Standard therapy had failed to control the tachycardia before. No side effects attributable to Ivabradine were noticed. Due to its mechanism of action Ivabradine is a promising novel agent for the therapy of tachycardia due to increased automaticity. Reports on the use of Ivabradine in young children or infants are rare, but show promising results for congenital junctional ectopic tachycardia. This report adds the second case of ectopic atrial tachycardia in this age group and novel treatment with Ivabradine to the literature.

Ivabradine: A Potential Therapeutic for Children With Refractory SVT

“…Ivabradine may suppress this automaticity resulting in rate control and effective reversal to sinus rhythm. Ivabradine's use in treating pediatric FAT has been likely portrayed in two case reports ( 30 , 32 ). One case, of a 12-month-old girl with refractory ectopic atrial tachycardia, was safely and effectively managed with a combination therapy of ivabradine and metoprolol.…”

“…One case, of a 12-month-old girl with refractory ectopic atrial tachycardia, was safely and effectively managed with a combination therapy of ivabradine and metoprolol. No adverse events were encountered, and a sinus rhythm was attained after 2 days of treatment ( 32 ). The second case was a 5-month-old infant with multifocal atrial tachycardia stabilized and reverted to single ectopic atrial tachycardia with ivabradine.…”

Use of ivabradine in a critically ill pediatric patient with recalcitrant ectopic atrial tachycardia and complex congenital heart disease

“…Given the automatic nature of EAT, some authors have reported use of ivabradine for this dysrhythmia in patients with structurally normal hearts. 14 , 15 However, to our knowledge, there are no reports in the literature of the use of ivabradine for EAT in a neonate with single-ventricle CHD. Atrial dilation in the setting of tricuspid regurgitation was the likely aggravating factor in the development of our patient’s EAT.…”

Tachycardia-induced cardiomyopathy secondary to incessant ectopic atrial tachycardia in two infants: Potential new indication for early initiation of enteral ivabradine

“…Considering the age, hemodynamic instability, and unavailability of electrophysiology laboratory, we started oral ivabradine based on the literature, and this was associated with a good response. [ 2 3 4 ] While conversion to sinus due to a delayed effect of amiodarone cannot be completely excluded, this is unlikely as sustained sinus rhythm was achieved with ivabradine despite stopping amiodarone. This was again evident on the second case where early initiation of ivabradine resulted in early achievement of sinus rhythm.…”

“…Ivabradine has been utilized so far in the literature for treatment in children with heart failure, EAT, multifocal atrial tachycardia, congenital, and postoperative junctional ectopic tachycardias. [ 1 2 3 4 5 6 7 ] We report here, the utility of ivabradinein two hemodynamically unstable infants with tachycardia-induced cardiomyopathy secondary to EAT. The two were managed differently, with earlier utilisation of ivabradine in the second patient, having learned from the first patient.…”