Ivabradine–Flecainide as Breakthrough Drug Combination for Congenital Junctional Ectopic Tachycardia: A Case Report and Literature Review

Marco, Giovanni Maria Di; Nigris, Angelica De; Pepe, Angela; Pagano, Antonio; Nardo, Giangiacomo Di; Tipo, Vincenzo

doi:10.3390/pediatric13040074

Cited by 4 publications

(6 citation statements)

References 22 publications

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“… 22 Recently, enteral ivabradine administered alone or in combination with other medications (amiodarone, flecainide) has been shown to be effective. 13 , 16 , 23 To date, there have been no reports using ivabradine in combination with procainamide for the management of postoperative JET. We describe a patient with JET refractory to initial measures with a progressively worsening postoperative status, in whom the addition of ivabradine to procainamide proved effective and safe.…”

Section: Discussionmentioning

confidence: 99%

“… 15 Additionally, prior case studies have described the benefits of amiodarone or flecainide in conjunction with ivabradine for the treatment of postoperative and congenital JET. 16 , 23 …”

Section: Discussionmentioning

confidence: 99%

“… 29 In addition, our patient did not develop bradycardia, hypotension, or worrisome ECG changes, extending the observation that ivabradine in these critically ill patients appears to be safe. 13 , 16 , 23 …”

Section: Discussionmentioning

confidence: 99%

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Combination Therapy of Ivabradine with Procainamide for the Management of Pediatric Postoperative Junctional Ectopic Tachycardia

Dasgupta

Johnsrude

2023

J Innov Cardiac Rhythm Manage.

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Pediatric postoperative junctional ectopic tachycardia (JET), although usually self-limited, may lead to significant morbidity and mortality. Anti-arrhythmic medications are often necessary to restore atrioventricular synchrony when non-pharmacological measures fail. Multiple drugs have been described for the management of postoperative JET, with enteral ivabradine being the latest addition. While safe administration of ivabradine has been described in combination with other anti-arrhythmics (amiodarone, flecainide), no study has described the use of ivabradine in conjunction with intravenous procainamide for the management of postoperative JET. Our case report describes the safe use of ivabradine and procainamide combination therapy in a young patient.

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Section: Discussionmentioning

confidence: 99%

“… 15 Additionally, prior case studies have described the benefits of amiodarone or flecainide in conjunction with ivabradine for the treatment of postoperative and congenital JET. 16 , 23 …”

Section: Discussionmentioning

confidence: 99%

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Combination Therapy of Ivabradine with Procainamide for the Management of Pediatric Postoperative Junctional Ectopic Tachycardia

Dasgupta

Johnsrude

2023

J Innov Cardiac Rhythm Manage.

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“…Ivabradine may cause negative inotropic and vasoconstrictive effects, arrhythmias, impaired intracardiac impulse propagation, or arterial hypotension. Rarely, dysphagia has been reported [5][6][7][8][9]. Case reports show beneficial effects in tachyarrhythmias, showing no increase in adverse events compared to use in adults.…”

Section: Review On Antiarrhythmic Drug Dosing In Childrenmentioning

confidence: 99%

Antiarrhythmic Drug Dosing in Children—Review of the Literature

Oeffl,

Schober,

Faudon

et al. 2023

Children

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Antiarrhythmic drug therapy represents a mainstay in pediatric arrhythmias. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential mistakes and even uncertainties with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.

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“…The overall incidence of dysrhythmias is 55.1 per 100,000 pediatric ED visits [ 1 ]. Nevertheless, the pediatric ED physician should be able to determine whether child requires immediate examination and referral to a cardiologist [ 2 , 3 ]. Sacchetti et al [ 4 ] conducted a retrospective review of cardiac dysrhythmias in children presenting to the ED, and revealed that sinus tachycardia was the most commonly reported dysrhythmia (50%), followed by supraventricular tachycardia (13%), nonspecific dysrhythmias (10.6%), bradycardia (6%), and atrial fibrillation (4.6%).…”

Section: Introductionmentioning

confidence: 99%

The diagnostic and therapeutic challenge of atrial flutter in children: a case report

De Nigris,

Arenella,

Di Nardo

et al. 2023

Ital J Pediatr

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Background Palpitations represent a common cause for consultation in the pediatric Emergency Department (ED). Unlike adults, palpitations in children are less frequently dependent from the heart, recognizing other causes. Case presentation A 11-year-old male came to our pediatric ED for epigastric pain, vomiting and palpitations. During the previous 6 month the patient was affected by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus). Electrocardiogram (ECG) revealed supraventricular tachycardia. Therefore, adenosine was administered unsuccessfully. The administration of adenosine, however, allowed us to make diagnosis of atypical atrial flutter. Multiple attempts at both electrical cardioversion, transesophageal atrial overdrive, and drug monotherapy were unsuccessful in our patient. Consequently, a triple therapy with amiodarone, flecainide, and beta-blocker was gradually designed to control the arrhythmic pattern with the restoration of a left upper atrial rhythm. There was not any evidence of sinus rhythm in the patient clinical history. Conclusions The present study underlines the rarity of this type of dysrhythmia in childhood and the difficulties in diagnosis and management, above all in a patient who has never showed sinus rhythm. Raising awareness of all available treatment options is essential for a better management of dysrhythmia in children

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Ivabradine–Flecainide as Breakthrough Drug Combination for Congenital Junctional Ectopic Tachycardia: A Case Report and Literature Review

Cited by 4 publications

References 22 publications

Combination Therapy of Ivabradine with Procainamide for the Management of Pediatric Postoperative Junctional Ectopic Tachycardia

Combination Therapy of Ivabradine with Procainamide for the Management of Pediatric Postoperative Junctional Ectopic Tachycardia

Antiarrhythmic Drug Dosing in Children—Review of the Literature

The diagnostic and therapeutic challenge of atrial flutter in children: a case report

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