Abstract
Flecainide is frequently used for treatment of cardiac arrhythmias in children. Due to concerns regarding increased mortality, there has been hesitancy to use flecainide in children with congenital heart disease (CHD) or cardiomyopathy (CM). The objective of this study was to describe trends in use of flecainide in children with CHD or CM and assess its association with cardiac arrest or death. Data from 42 children’s hospitals contained in the PHIS database (2004–2011) were analyzed. All patients with CHD or CM receiving anti-arrhythmic therapy for supraventricular arrhythmias were reviewed. Trends in flecainide use were analyzed, and the incidence of cardiac arrest or death was compared to patients receiving other anti-arrhythmics. There were 3,544 pts with CHD or CM who received anti-arrhythmic therapy (median age 73 days). Flecainide was administered in 229 pts (6.5 %). There was a trend toward increased use of flecainide in this population, increasing from 4.6 % in 2004 to 8.7 % in 2011 (p = 0.07). The incidence of cardiac arrest in patients with CHD or CM receiving flecainide was 3.0 % with an overall mortality of 4.3 %. The mortality was 2.9 % in pts with CM and nobody with single ventricle physiology died. Based on multivariable analysis, when compared to pts with CHD or CM receiving other anti-arrhythmics, there was no difference in the incidence of cardiac arrest (p = 0.31) or death (p = 0.28). Flecainide use in children with CHD or CM has increased in recent years. The incidence of cardiac arrest or death with flecainide administration in this cohort appears comparable to other anti-arrhythmic agents.
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Abbreviations
- CHD:
-
Congenital heart disease
- CM:
-
Cardiomyopathy
- SCA:
-
Sudden cardiac arrest
- SVT:
-
Supraventricular tachycardia
References
Bouhouch R, El Houari T, Fellat I, Arharbi M (2008) Pharmacological therapy in children with nodal reentry tachycardia: when, how and how long to treat the affected patient. Curr Pharm Des 14(8):766–769
Echt DS, Liebson PR, Mitchell LB et al (1991) Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the cardiac arrhythmia suppression trial. N Engl J Med 324:781–788
Fish FA, Gillette PC, Benson DW (1991) Proarrhythmia, cardiac arrest and death in young patients receiving encainide and flecainide. J Am Coll Cardio 18(2):356–365
Hopson JR, Buxton AE, Rinkenberger RL, Nademanee K, Heilman JM, Kienzle MG (1996) Safety and utility of flecainide acetate in the routine care of patients with supraventricular tachyarrhythmias: results of a multicenter trial. Am J Cardiol 77:72a–82a
Paul T, Bertram H, Bokenkamp R, Hausdorf G (2000) Supraventricular tachycardia in infants, children and adolescents: diagnosis, and parmacological and interventional therapy. Paediatr Drugs 2(3):171–181
Perry JC, Garson A (1992) Flecainide acetate for treatment of tachyarrhythmias in children: review of world literature on efficacy, safety, and dosing. Am Heart J 124(6):1614–1621
Pfammatter JP, Paul T (1999) Idiopathic ventricular tachycardia in infancy and childhood: a multicenter study on clinical profile and outcome. Working group on dysrhythmias and electrophysiology of the association for European pediatric cardiology. J Am Coll Cardiol 33(7):2067–2072
Pflaumer A, Davis A (2012) Guidelines for the diagnosis and management of catecholaminergic polymorphic ventricular tachycardia. Heart Lung Circ 21:96–100
Pratt CM, Moye LA (1990) The Cardiac Arrhythmia Suppression Trial: background, interim results and implications. Am J Cardiol 65(4):20B–29B
Seslar SP, Garrison MM, Larison C, Salerno JC: A multi-institutional analysis of inpatient treatment for supraventricular tachycardia in newborns and infants. Pediatr Cardiol 2012; Epub
The Cardiac Arrhythmia Suppression Trial (1989) (CAST) Investigators, preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 321:405–412
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Moffett, B.S., Valdes, S.O., Lupo, P.J. et al. Flecainide Use in Children with Cardiomyopathy or Structural Heart Disease. Pediatr Cardiol 36, 146–150 (2015). https://doi.org/10.1007/s00246-014-0978-3
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DOI: https://doi.org/10.1007/s00246-014-0978-3