Skip to main content

Advertisement

SpringerLink
Log in

Oral Albuterol Treatment in Three Pediatric Patients with Bradycardia: A Novel Therapy

  • Case Report
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Clinically significant bradycardia is an uncommon problem in children, but one that can cause significant morbidity and sometimes necessitates implantation of a pacemaker. The most common causes of bradycardia are complete heart block (CHB), which can be congenital or acquired, and sinus node dysfunction, which is rare in children with structurally normal hearts. Pacemaker is indicated as therapy for the majority of children with CHB, and while early mortality is lower in postnatally diagnosed CHB than in fetal CHB, it is still up to 16%. In young children, less invasive transvenous pacemaker systems can be technically challenging to place and carry a high risk of complications, often necessitating surgical epicardial pacemaker placement, which usually entails a median sternotomy. We report three cases of pediatric patients referred for pacemaker implantation for different types of bradycardia, treated at our institution with oral albuterol with therapeutic results that avoided the need for surgical pacemaker implantation at that time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Writing Committee Members, Shah MJ, Silka MJ et al (2021) 2021 PACES expert consensus statement on the indications and management of cardiovascular implantable electronic devices in pediatric patients. Heart Rhythm 18(11):1888–1924. https://doi.org/10.1016/j.hrthm.2021.07.038

    Article  PubMed  Google Scholar 

  2. Michaëlsson M, Engle MA (1972) Congenital complete heart block: an international study of the natural history. Cardiovasc Clin 4(3):85–101

    PubMed  Google Scholar 

  3. Steinberg L (2023) Congenital heart block. Cardiol Clin 41(3):399–410. https://doi.org/10.1016/j.ccl.2023.03.002

    Article  PubMed  Google Scholar 

  4. Baruteau AE, Pass RH, Thambo JB, Behaghel A, Le Pennec S, Perdreau E, Combes N, Liberman L, McLeod CJ (2016) Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. Eur J Pediatr 175(9):1235–1248. https://doi.org/10.1007/s00431-016-2748-

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Jaeggi ET, Hamilton RM, Silverman ED, Zamora SA, Hornberger LK (2002) Outcome of children with fetal, neonatal or childhood diagnosis of isolated congenital atrioventricular block. A single institution’s experience of 30 years. J Am Coll Cardiol 39(1):130–137. https://doi.org/10.1016/s0735-1097(01)01697-7

    Article  PubMed  Google Scholar 

  6. Michaëlsson M, Jonzon A, Riesenfeld T (1995) Isolated congenital complete atrioventricular block in adult life. A prospect study. Circulation 92(3):442–449. https://doi.org/10.1161/01.cir.92.3.442

    Article  PubMed  Google Scholar 

  7. Eronen M (2001) Long-term outcome of children with complete heart block diagnosed after the newborn period. Pediatr Cardiol 22(2):133–137. https://doi.org/10.1007/s002460010179

    Article  CAS  PubMed  Google Scholar 

  8. Fischbach PS, Frias PA, Strieper MJ, Campbell RM (2007) Natural history and current therapy for complete heart block in children and patients with congenital heart disease. Congenit Heart Dis 2(4):224–234. https://doi.org/10.1111/j.1747-0803.2007.00106.x

    Article  PubMed  Google Scholar 

  9. Berul CI (2008) Defibrillator indications and implantation in young children. Heart Rhythm 5(12):1755–1757. https://doi.org/10.1016/j.hrthm.2008.07.027

    Article  PubMed  Google Scholar 

  10. Carroll CL, Sala KA (2013) Pediatric status asthmaticus. Crit Care Clin 29(2):153–166. https://doi.org/10.1016/j.ccc.2012.12.001

    Article  PubMed  Google Scholar 

  11. Rachelefsky GS, Katz RM, Siegel SC (1982) Oral albuterol in the treatment of childhood asthma. Pediatrics 69(4):397–403

    Article  CAS  PubMed  Google Scholar 

  12. Price AH, Clissold SP (1989) Salbutamol in the 1980s. A reappraisal of its clinical efficacy. Drugs 38(1):77–122. https://doi.org/10.2165/00003495-198938010-00004

    Article  CAS  PubMed  Google Scholar 

  13. Evans CH, Duby JJ, Berry AJ, Schermer CR, Cocanour CS (2014) Enteral albuterol decreases the need for chronotropic agents in patients with cervical spinal cord injury-induced bradycardia. J Trauma Acute Care Surg 76(2):297–301 (Discussion 301–302). https://doi.org/10.1097/TA.0000000000000118

    Article  CAS  PubMed  Google Scholar 

  14. Lim-Hing K, Massetti J, Pajoumand M, Gupta S, Jenkins R, Hassan M, Paganelli P, Parikh G, Chang WT, Schwartzbauer G, Stein D, Badjatia N (2022) Impact of enteral albuterol on bradycardic events after acute cervical spinal cord injury. Neurocrit Care 36(3):840–845. https://doi.org/10.1007/s12028-021-01384-0

    Article  CAS  PubMed  Google Scholar 

  15. Rollstin A, Carey MC, Doherty G, Tawil I, Marinaro J (2016) Oral albuterol to treat symptomatic bradycardia in acute spinal cord injury. Intern Emerg Med 11(1):101–105. https://doi.org/10.1007/s11739-015-1324-3

    Article  PubMed  Google Scholar 

  16. Robinson BV, Ettedgui JA, Sherman FS (2001) Use of terbutaline in the treatment of complete heart block in the fetus. Cardiol Young 11(6):683–686. https://doi.org/10.1017/s1047951101001123

    Article  CAS  PubMed  Google Scholar 

  17. Yoshida H, Iwamoto M, Sakakibara H et al (2001) Treatment of fetal congenital complete heart block with maternal administration of beta-sympathomimetics (terbutaline): a case report. Gynecol Obstetric Invest 52(2):142–144

    Article  CAS  Google Scholar 

  18. Chan AY, Silverman RK, Smith FC, Geifman-Holtzman O (1999) In utero treatment of fetal complete heart block with terbutaline. A case report. J Reprod Med 44(4):385–387

    CAS  PubMed  Google Scholar 

  19. Cuneo BF, Lee M, Roberson D et al (2010) A management strategy for fetal immune-mediated atrioventricular block. J Matern Fetal Neonatal Med 23(12):1400–1405. https://doi.org/10.3109/14767051003728237

    Article  PubMed  Google Scholar 

  20. Sivarajah J, Huggon IC, Rosenthal E (2003) Successful management of fetal hydrops due to congenitally complete atrioventricular block. Cardiol Young 13(4):380–383

    Article  PubMed  Google Scholar 

  21. Jaeggi ET, Fouron JC, Silverman ED, Ryan G, Smallhorn J, Hornberger LK (2004) Transplacental fetal treatment improves the outcome of prenatally diagnosed complete atrioventricular block without structural heart disease. Circulation 110(12):1542–1548. https://doi.org/10.1161/01.CIR.0000142046.58632.3A

    Article  PubMed  Google Scholar 

  22. Groves AM, Allan LD, Rosenthal E (1995) Therapeutic trial of sympathomimetics in three cases of complete heart block in the fetus. Circulation 92(12):3394–3396. https://doi.org/10.1161/01.cir.92.12.3394

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding was provided for this case series.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Adam M. Butensky, William F. Patten, Eric S. Silver & Leonardo Liberman

Authors
  1. Adam M. Butensky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William F. Patten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eric S. Silver
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leonardo Liberman
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AB wrote the main manuscript text and prepared the figures. AB and WP performed literature review and compiled the patient histories used for the clinical vignettes. All authors were involved in compiling the patient cases for this series, and reviewed the manuscript.

Corresponding author

Correspondence to Adam M. Butensky.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Butensky, A.M., Patten, W.F., Silver, E.S. et al. Oral Albuterol Treatment in Three Pediatric Patients with Bradycardia: A Novel Therapy. Pediatr Cardiol 45, 441–445 (2024). https://doi.org/10.1007/s00246-023-03379-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-023-03379-4

Keywords

Search

Navigation