Verapamil in the treatment of paroxysmal supraventricular tachycardia in infants and children

Shahar, Eli; Barzilay, Zohar; Frand, Mira

doi:10.1016/s0022-3476(81)80672-5

Cited by 37 publications

(13 citation statements)

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“…Although the possible therapeutic role of calcium channel blockade has been suggested (35), several animals not included in our analysis demonstrated marked bradycardia and hypotension during prolonged infusions of tolazoline and verapamil, suggesting that this combination may be poorly tolerated, especially in the asphyxiated newborn. Furthermore, bradycardia and hypotension have been reported in infants treated with verapamil for supraventricular tachycardia (40). Similarly, although the combined infusion of tolazoline and phentolamine augmented pulmonary blood flow in the fetal lamb, its potential therapeutic role remains unknown.…”

Section: Effects Of Histaminergic Blockade On Response To Bolus Injecmentioning

confidence: 99%

Adaptation of Fetal Pulmonary Blood Flow to Local Infusion of Tolazoline

1986

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ABSTRAa. Although tolazoline is the most commonly used drug in the treatment of neonatal pulmonary hypertension, its mode of action and efficacy remain incompletely understood. In order to study the effects of tolazoline on a high resistance pulmonary circulation and to better understand mechanisms that control pulmonary vascular tone and reactivity in the fetus, we infused tolazoline either continuously or as bolus into the left pulmonary artery of 15 chronically instrumented, normoxic fetal lambs during late gestation. The vasodilatory effects of bolus injections of tolazoline (2.5 mg) were inhibited by the prior administration of the histaminergic receptor blockers, cimetidine (56%), diphenhydramine (56%), or both (100%). During the continuous infusion of tolazoline (4.5 mg/h for 9 min), pulmonary blood flow to the left lung increased from 61 f 6 ml/min (mean f SE; control) to 100 k 10 (peak) at 30 min ( p < 0.001). However, following this initial vasodilatation, pulmonary blood flow steadily decreased toward control values by 90 min, despite the continued infusion of tolazoline ( p < 0.001). Although the calcium channel blocker, verapamil, and the a-adrenergic blocker, phentolamine, had little effect on fetal pulmonary blood flow when infused alone, both drugs increased the vasodilatory response to tolazoline (p < 0.001). We conclude that tolazoline effects pulmonary vasodilatation by a histaminergic mechanism and that subsequent refractoriness to the drug is a calcium-dependent process which may be partially mediated by an a-adrenergic mechanism. (Pediatr Res 20: 1131-1135,1986 Abbreviations PPHN, persistent pulmonary hypertension of the newborn LPA, left pulmonary artery PPHN accompanies a variety of cardiopulmonary disorders, including asphyxia, meconium aspiration, sepsis, hyaline membrane disease, and congenital diaphragmatic hernia, or occurs as an idiopathic disorder ("persistent fetal circulation") (1-6). Morbidity and mortality of PPHN remains high despite aggressive therapeutic interventions, including hyperventilation, inotropic support of the systemic circulation, and pharmacologic manipulation of the pulmonary vascular bed (7, 8). Attempts to find a Received January 3 1. 1986; accepted June 9, 1986. Correspondence Steven H. Abman, M.D., Pediatric Pulmonary Medicine, Box C-220, University of Colorado Health Scicnces Center, 4200 East Ninth Avenue, Denver. CO 80262.Supported by grants from the American Lung Association, American Thoracic Society, the Colorado Lung Association, and National Institutes of Health Grants HD-01860 and HD-0078 1.vasodilator which selectively and consistently lowers pulmonary vascular resistance without causing systemic hypotension or other side effects have been unsuccessful. Despite its complex pharmacology, and although its current use is largely based on case reports or uncontrolled clinical studies, tolazoline has evolved as the primary vasoactive drug used in the treatment of PPHN (4, 5, 7, 9-12). Although many newborns with PPHN treated with tolazoline appear to ...

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Section: Effects Of Histaminergic Blockade On Response To Bolus Injecmentioning

confidence: 99%

Adaptation of Fetal Pulmonary Blood Flow to Local Infusion of Tolazoline

1986

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“…The results indicate that verapamil has both age-and dose-dependent cardiovascular effects in newborn swine and suggest that verapamil be used with caution in infants. (Pediatr Res 20: 428-432, 1986) Abbreviations AoP, aortic pressure -AoP, mean aortic pressure ECG, electrocardiogram HR, heart rate LV, left ventricular LV dP/dt max, index of LV contractility R, resistance iv, intravenous While verapamil is widely used in children and infants for the treatment of supraventricular tachycardia (1)(2)(3)(4)(5), adverse effects such as profound hypotension and arterioventricular block have been reported (1,4,6,7). In piglets (aged 18 a 6 days) with hypoxic pulmonary hypertension, verapamil infusion (150 pg/ kg over 2 min) decreased systemic and pulmonary artery pressures (8).…”

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confidence: 99%

Age-Dependent Cardiovascular Effects of Verapamil in Newborn Swine

et al. 1986

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ABSTRACT. Since there are limited studies concerning the hemodynamic effects of verapamil in pediatric patients, cardiovascular effects of clinical doses (100 or 300 pg/kg) of verapamil, given as a 2-min intravenous infusion, were examined in sodium pentobarbital anesthetized swine, aged 1 day (n = 15) and 2 wk (n = 18). Aortic and left ventricular pressures, index of left ventricular contractility, heart rate, and phasic superior mesenteric, renal, and femoral arterial flows were recorded; mean aortic pressure and vascular resistances were calculated. Maximum changes in cardiovascular function (mean %A -C SEM) occurred at the end of the infusion. Mean aortic pressure and index of left ventricular contractility decreased in all animals; responses were larger in magnitude with the higher dose. By 30 min after infusion of 300 pg/kg verapamil had ended, mean aortic pressure in both 1 day and 2 wk olds and index of left ventricular contractility and femoral flow in 1 day olds were still decreased. During infusion of verapamil, heart rate decreased (-11.6 + 2.9) to the high dose in 1 day olds but increased (+6.4 +. 2.7) to 100 and 300 pglkg verapamil in 2 wk olds. After infusion of 300 pglkg verapamil ended, heart rate decreased and reached the nadir (-10.0 f 2.9) by 10 min in 2 wk olds. Decreases in renal resistance (-7.6 f 1.7) were not dose dependent while superior mesenteric resistance decreased (-12.9 2 2.7) only to low dose verapamil in 2 wk olds. In 1 day olds decreases in renal and superior mesenteric resistance were not sustained throughout the infusion. The results indicate that verapamil has both age-and dose-dependent cardiovascular effects in newborn swine and suggest that verapamil be used with caution in infants. (Pediatr Res 20: 428-432, 1986) Abbreviations AoP, aortic pressure -AoP, mean aortic pressure ECG, electrocardiogram HR, heart rate LV, left ventricular LV dP/dt max, index of LV contractility R, resistance iv, intravenous While verapamil is widely used in children and infants for the treatment of supraventricular tachycardia (1-5), adverse effects such as profound hypotension and arterioventricular block have been reported (1, 4, 6, 7). In piglets (aged 18 a 6 days) with hypoxic pulmonary hypertension, verapamil infusion (150 pg/ kg over 2 min) decreased systemic and pulmonary artery pressures (8). In puppies a bolus injection of 400 pg/kg verapamil reduced stroke volume and blood flow velocities in aorta and carotid and femoral arteries (9); these effects were not observed in adult dogs.Since there is little information available concerning the cardiac and regional circulatory effects of verapamil in the newborn period (%-lo), we undertook to study the hemodynamic responses to verapamil in two ages of young swine to further the understanding of the pharmacology of verapamil in pediatrics as a function of postnatal development. MATERIALS AND METHODSAnimal preparation. Two age groups of neonatal swine were used in this study: 1 day (< 24 h old; n = 15) and 2 wk (12-16 days; n = 8). These t...

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“…Intravenous verapamil is frequently used in acute treatment of supraventricular tachycardia in infants and children (Shahar et al, 1981;Soler-Soler et al, 1979). This drug has also been used to slow the ventricular rate in atrial flutter and fibrillation in adults.…”

Section: Discussionmentioning

confidence: 99%

Successful management of atrial flutter in a newborn with verapamil

Casta

Wolf

Richardson

et al. 1985

Clinical Cardiology

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Summary:Verapamil has become a popular antiarrhythmic drug for the acute management of supraventricular tachycardia in infants and children. A fullterm, 1 -hour-old infant presented with supraventricular tachycardia and hypotension that did not respond to vagal maneuvers and direct current cardioversion. After intravenous verapamil, the heart rate slowed and the underlying rhythm was atrial flutter.Key words: newborn infants, verapamil, supraventricular tachycardia Case ReportThis I-hour-old, 3.31 kg, full-term male infant was born by vaginal delivery to an 18-year-old mother following a pregnancy complicated by pre-eclampsia. Fetal monitoring revealed a fast heart rate. Because of preeclampsia and fetal tachycardia, labor was induced. Apgars were 6 and 8 at 1 min and 5 min, respectively, and the initial heart rate was 280 beatdmin. The infant's perfusion was poor. Blood pressure was 50/42 mmHg and failed to improve after plasmanate infusion, Heart exam was normal, but all peripheral pulses were equally weak. No hepatosplenomegaly was present. An electrocardiographic rhythm strip (Fig. 1 A) demonstrated supraventricular tachycardia which did not respond to vagal maneuvers. Direct current cardioversion was attempted three times without conversion. Three minutes after intravenous verapamil (0.075 mg/kg), the heart rate fell to 160 beats/min and atrial flutter was seen to be the underlying rhythm (Fig. IB). A second dose of verapamil (total dosage 0.15 mg/kg) resulted in sinus rhythm (Fig. 1C). The blood pressure rose to 62/42 mmHg and peripheral perfusion improved. A 12-lead electrocardiogram during sinus rhythm showed no evidence of pre-excitation. The chest radiogram was normal. Two-dimensional echocardiography showed no structural abnormalities. The infant was started on digoxin for maintenance therapy but another dose of verapamil (0.075 mg/kg) for recurrent supraventricular tachycardia was necessary 24 h after digitalization. This resulted in sinus rhythm. The infant was discharged at age 8 days in sinus rhythm with a digoxin blood level of 2.2 ng/ml. At 1 month, he was readmitted in shock as a result of recurrent supraventricular tachycardia (300 beatdmin). On admission his blood pressure was 45/27 mmHg . Intravenous verapamil (0.15 mg/kg) slowed the heart rate to 150 beats/min and atrial flutter with variable block was again noted. The blood pressure increased to 70/40 mmHg. During hospitalization, he had several nonsustained (duration of less than 20 min) episodes of atrial flutter with varying degrees of atrioventricular block. He was started on oral propranolol which prevented any recurrence of supraventricular tachycardia. The infant was discharged on digoxin (level 1.4 ng/ml) and propranolol. At follow-up (age 3 months) he was still in sinus rhythm.

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Verapamil in the treatment of paroxysmal supraventricular tachycardia in infants and children

Cited by 37 publications

References 16 publications

Adaptation of Fetal Pulmonary Blood Flow to Local Infusion of Tolazoline

Adaptation of Fetal Pulmonary Blood Flow to Local Infusion of Tolazoline

Age-Dependent Cardiovascular Effects of Verapamil in Newborn Swine

Successful management of atrial flutter in a newborn with verapamil

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