The Medical Management of Pediatric Arrhythmias

Abstract

Arrhythmias are an important cause of morbidity and mortality in children. Despite recent technological advances in treatment, pharmacologic therapy remains the most common treatment modality for pediatric arrhythmias. The choice of antiarrhythmic agent, the duration of therapy, and the dosing schedule depend on multiple factors including the recurrence risk and the arrhythmia burden (the latter being determined by the hemodynamic effect of the arrhythmia), and the frequency and duration of episodes. As with all pediatric medications, consideration must be given to the drug formulation, palatability, adverse effects and adherence issues. There are very few randomized trials available to guide the choice of therapy for pediatric arrhythmias, and thus treatment options often reflect physician or institutional preferences. Although various classification schemes exist, we classify antiarrhythmic agents based on their primary site of action: atrial muscle/accessory pathway (class IA, IC, and III agents); the atrioventricular node (beta-blockers, calcium channel blockers, digoxin, and class III agents); or ventricular muscle (class I and III agents). This type of categorization assists in the approach to treatment required for each type of arrhythmia encountered.

Early Postoperative Arrhythmias after Paediatric Cardiac Surgery

“…Arrhythmias haPP.ened in 57 of 402 patients (14.2%). Notwithstanding, the circulation of arrythmia types was unique in relation to our investigation; the most well-known sorts of arrhythmia were junctional ectopic tachycardia (21), supraventricular tachycardia (15), and arteriovenous square (6). Moreover, Delaney et al, [11] meant to decide the occurrence and danger factors related with the improvement of arrhythmias following medical procedure in a pediatric populace.…”

“…Tachyarrhythmia is generally experienced after pediatric heart medical procedure. By and large, it tends to be grouped by their source into restricted QRS complex (≤0.09 s) or wide QRS complex tachycardia (>0.09 s) [6].In specific, junctional ecto-pic tachycardia (JET) stays an infamous arrhythmia that draws out emergency unit remain and a few times prompts mortality. A few reports have taken a gander at the occurrence, hazard variables, and the executives of these arrhythmias.…”

Study design for control of HEART rate in inFant and child tachyarrhythmia with heart failure Using Landiolol (HEARTFUL): A prospective, multicenter, uncontrolled clinical trial

“…The available drugs for treating tachyarrhythmias include adenosine, b-blockers, calcium channel blockers, digoxin, sodium channel blockers, and potassium channel blockers [1,7,8]. In contrast to the double-blind trials of drugs for treating arrhythmia in adult patients, studies in pediatric patients have not only been scarce, but also small in scale.…”

“…In contrast to the double-blind trials of drugs for treating arrhythmia in adult patients, studies in pediatric patients have not only been scarce, but also small in scale. Consequently, during treatment of such pediatric patients, careful observation is required to check their individual responses and adverse events (AEs) through monitoring of symptoms, 12-lead electrocardiogram (ECG), and vital signs [7,9]. In addition, only a few agents have been approved for use in pediatric patients, namely propranolol [10], digitalis preparations [11][12][13][14], flecainide [15], and verapamil [16,17] in Japan.…”

Approach to Wide Complex Tachycardia in Paediatric Patients

“…-Tachycardia persistence or recurrence -Duration of tachycardia episodes -Symptoms related to the WCT including irritability or poor feeding in infants, syncope, pallor, hemodynamic compromise, or aborted cardiac arrest -Presence of structural cardiac abnormalities or congenital heart disease -Evidence of cardiac dysfunction -Natural history of the condition The remainder of this article will review the subacute and chronic management of SVT and VT, with a special focus on VT. For further information on the assessment and chronic management of SVT, we refer the reader to resources outlined in the references. 7,10,11 Supraventricular Tachycardia…”