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Safety Issues in the Treatment of Paediatric Supraventricular Tachycardias

Drug Safety volume 18, pages 345–356 (1998)Cite this article

Summary

Paroxysmal supraventricular tachycardia caused by atrioventricular re-entry is the most frequent arrhythmia in children of all age groups. It represents the most frequent clinical situation where antiarrhythmic drug therapy has to be considered in a child.

Acute termination of an episode of tachycardia in all paediatric age groups is nowadays best achieved with an intravenous bolus injection of adenosine. Since the introduction of adenosine into clinical practice, the need to proceed to electrocardioversion has been limited to the infant (or in rare cases an older child) with severe cardiovascular collapse. In the haemodynamically stable infant or child, several other antiarrhythmic agents such as flecainide or propafenone can be used with relative safety and with a high probability of immediate success. The same is true for verapamil, although intravenous administration should be avoided in the first year of life.

In newborns and in infants with first presentation of an episode of tachycardia, drug prophylaxis of recurrences is usually recommended for the whole of the first year of life. Prophylactic treatment may consist of oral digoxin as first choice, with a β-blocker as an alternative. In an infant with Wolff-Parkinson-White syndrome it may be wise to avoid digoxin and to start treatment with a β-blocker. Antiarrhythmic class Ic drugs such as propafenone or flecainide, and the class III agent Sotalol, are widely used as the next steps of therapy when digoxin and β-blockers fail to prevent recurrences. These agents are about equivalent with regard to their efficacy and risk profile. Amiodarone is considered to be an agent that should be reserved for use in situations when the tachycardia is refractory to the previously named agents. Older children may commence treatment with a β-blocker and the subsequent steps of treatment are the same as those for infants.

Curative catheter ablation of accessory pathways has been shown to be as efficient and well tolerated in the paediatric age group as it is in adults. This treatment option is nowadays quite often offered to older children. However, in infants and smaller children, ablation is used as a last resort.

Rare forms of paediatric supraventricular tachycardia (other than atrioventricular re-entry through the atrioventricular node or accessory pathways) are occasionally difficult to treat and present special problems. For each of these arrhythmias, a specially tailored individual therapeutic approach is needed.

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References

  1. Garson A, Gillette PC, McNamara DG. Supraventricular tachycardia in children: clinical features, response to treatment and long-term follow-up in 217 patients. J Pediatr 1981; 98: 875–82

    PubMed  Article  Google Scholar 

  2. Perry JC, Garson A. Supraventricular tachycardia due to Wolff-Parkinson-White syndrome in children: early disappearance and late recurrence. J Am Coll Cardiol 1990: 16: 1215–20

    PubMed  Article  CAS  Google Scholar 

  3. Pfammatter JP, Paul T, Lehmann C, et al. Efficacy and pro-arrhythmia of oral Sotalol in pediatric patients. J Am Coll Cardiol 1995; 26: 1002–7

    PubMed  Article  CAS  Google Scholar 

  4. Fish FA, Gillette PC, Benson VD. Proarrhythmia, cardiac arrest and sudden death in young patients receiving encainide and flecainide. J Am Coll Cardiol 1991; 18: 356–65

    PubMed  Article  CAS  Google Scholar 

  5. Ko JK, Deal BJ, Strasburger JF, et al. Supraventricular tachycardia mechanism and their age distribution in pediatric patients. Am J Cardiol 1992; 69: 1028–32

    PubMed  Article  CAS  Google Scholar 

  6. Overholt ED, Rheuban KS, Gutgesell HP, et al. Usefulness of adenosine for arrhythmias in infants and children. Am J Cardiol 1988; 61: 336–40

    PubMed  Article  CAS  Google Scholar 

  7. Till J, Shinebourne EA, Rigby ML, et al. Efficacy and safety of adenosine in the treatment of supraventricular tachycardia in infants and children. Br Heart J 1989; 62: 204–11

    PubMed  Article  CAS  Google Scholar 

  8. Pfammatter JP, Paul T, Bachmann D, et al. Efficacy and diagnostic use of adenosine in infants and children. Z Kardiol 1995; 84: 243–9

    PubMed  CAS  Google Scholar 

  9. Paul T, Pfammatter JP. Adenosine: an effective and safe antiarrhythmic drug in pediatrics. Pediatr Cardiol 1997; 18: 118–26

    PubMed  Article  CAS  Google Scholar 

  10. De Groff CG, Silka MJ. Bronchospasm after intravenous administration of adenosine in a patient with asthma. J Pediatr 1994; 125: 822–3

    Article  Google Scholar 

  11. Camm AJ, Garratt CJ. Adenosine and supraventricular tachycardia. N Engl J Med 1991; 325: 1621–9

    PubMed  Article  CAS  Google Scholar 

  12. Kipel G, Rossi AF, Steinberg LG, et al. Malignant wide complex tachycardia after adenosine administration to a postoperative pediatric patient with congenital heart disease. Pediatr Cardiol 1995; 16: 36–7

    PubMed  Article  CAS  Google Scholar 

  13. Romer M, Candinas R. Adenosine-induced non-sustained polymorphic ventricular tachycardia. Eur Heart J 1994; 15: 281–2

    PubMed  CAS  Google Scholar 

  14. Porter CJ, Garson A, Gillette FC. Verapamil: an effective calcium blocking agent for pediatric patients. Pediatrics 1983; 71: 748–55

    PubMed  CAS  Google Scholar 

  15. Shahar E, Barzilay Z, Frand M. Verapamil in the treatment of paroxysmal supraventricular tachycardia in infants and children. J Pediatr 1981; 98: 323–6

    PubMed  Article  CAS  Google Scholar 

  16. Greco R, Musto B, Arienzo V. Treatment of paroxysmal supraventricular tachycardia in infancy with digitalis, ATP and verapamil: a comparative study. Circulation 1982; 66: 504–8

    PubMed  Article  CAS  Google Scholar 

  17. Epstein ML, Kiel EA, Victoria BE. Cardiac decompensation following verapamil therapy in infants with supraventricular tachycardia. Pediatrics 1985; 75: 737–40

    PubMed  CAS  Google Scholar 

  18. Radford D. Side effects of verapamil in infants. Arch Dis Child 1983; 58: 465–6

    PubMed  Article  CAS  Google Scholar 

  19. Rankin AC, Rae AP, Cobbe SM. Misuse of intravenous verapamil in patients with ventricular tachycardia. Lancet 1987; II: 472–3

    Article  Google Scholar 

  20. Griffith MJ, Ward DE, Linker NJ, et al. Adenosine in the diagnosis of broad complex tachycardia. Lancet 1988; I: 672–5

    Article  Google Scholar 

  21. Reimer A, Paul T, Kallfelz HC. Efficacy and safety of intravenous and oral propafenone in pediatric cardiac arrhythmias. Am J Cardiol 1991; 68: 741–4

    PubMed  Article  CAS  Google Scholar 

  22. Vignati G, Mauri L, Figini A. The use of propafenone in the treatment of tachydysrhythmias in children. Eur Heart J 1993; 14: 546–50

    PubMed  Article  CAS  Google Scholar 

  23. Weber H, Eigster G, Wesselhoeft H. Propafenone in the treatment of dysrhythmias in infants and children. Monatsschr Kinderheilk 1981; 129: 410–3

    CAS  Google Scholar 

  24. Paul T, Janousek J. New antiarrhythmic drugs in pediatric use: propafenone. Pediatr Cardiol 1994; 15: 190–7

    PubMed  Article  CAS  Google Scholar 

  25. Musto B, Onofrio A, Cavallaro C, et al. Electrophysiologic effects and clinical efficacy of flecainide in children with recurrent paroxysmal supraventricular tachycardia. Am J Cardiol 1988; 62: 229–33

    PubMed  Article  CAS  Google Scholar 

  26. Ward DE, Jones S, Shinebourne EA. Use of flecainide acetate for refractory junctional tachycardias in children with the Wolff-Parkinson-White syndrome. Am J Cardiol 1986; 57: 787–90

    PubMed  Article  CAS  Google Scholar 

  27. Till JA, Rowland E, Shinebourne EA, et al. Treatment of refractory supraventricular arrhythmias with flecainide acetate. Arch Dis Child 1987; 62: 247–52

    PubMed  Article  CAS  Google Scholar 

  28. Wren C, Campell RW. The response of pediatric arrhythmias to intravenous and oral flecainide. Br Heart J 1987; 57: 171–5

    PubMed  Article  CAS  Google Scholar 

  29. Schneeweiss A. New antiarrhythmic drugs: flecainide. Pediatr Cardiol 1990; 11: 143–27

    PubMed  Article  CAS  Google Scholar 

  30. Benson DW, Dunnigan A, Green TP, et al. Periodic procainamide for paroxysmal tachycardia. Circulation 1985; 72: 147–52

    PubMed  Article  Google Scholar 

  31. Till JA, Shinebourne EA. Supraventricular tachycardia: diagnosis and current acute management. Arch Dis Child 1991; 66: 647–52

    PubMed  Article  CAS  Google Scholar 

  32. Jordaens L, Gorgels A, Stroobandt R, et al. Efficacy and safety of intravenous Sotalol for termination of paroxysmal supraventricular tachycardia. Am J Cardiol 1991; 68: 35–40

    PubMed  Article  CAS  Google Scholar 

  33. Pfammatter JP, Paul T. New antiarrhythmic drug in pediatric use: sotalol. Pediatr Cardiol 1997; 18: 28–34

    PubMed  Article  CAS  Google Scholar 

  34. Perry JC, Fenrich AL, Hülse JE, et al. Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol. J Am Coll Cardiol 1996; 27: 1246–50

    PubMed  Article  CAS  Google Scholar 

  35. Paul T, Guccione P. New antiarrhythmic drug in pediatric use: amiodarone. Pediatr Cardiol 1994; 15: 132–8

    PubMed  Article  CAS  Google Scholar 

  36. Sreeram N, Wren C. Supraventricular tachycardia in infants: response to initial treatment. Arch Dis Child 1990; 65: 127–9

    PubMed  Article  CAS  Google Scholar 

  37. Deal BJ, Keane JF, Gillette PC, et al. WPW-syndrome and supraventricular tachycardia during infancy: management and follow-up. J Am Coll Cardiol 1985; 5: 130–5

    PubMed  Article  CAS  Google Scholar 

  38. Weindling SN, Saul JP, Walsh EP. Efficacy and risks of medical therapy for supraventricular tachycardia in neonates and infants. Am Heart J 1996; 131: 66–72

    PubMed  Article  CAS  Google Scholar 

  39. O’sullivan JJ, Gardiner HM, Wren C. Digoxin or flecainide for prophylaxis of supraventricular tachycardia in infants. J Am Coll Cardiol 1995; 26: 991–4

    PubMed  Article  Google Scholar 

  40. Pfammatter JP, Stocker FP. Role of digoxin in the oral long term treatment of supraventricular tachycardia in infancy. Eur J Pediatr 1998; 157: 101–6

    PubMed  Article  CAS  Google Scholar 

  41. Benson DW, Dunnigan A, Benditt DG, et al. Prediction of digoxin treatment failure in infants with supraventricular tachycardia: role of transoesophageal pacing. Pediatrics 1985; 75: 288–93

    PubMed  Google Scholar 

  42. Byrum CJ, Wahl RA, Behrenct DM, et al. Ventricular fibrillation associated with use of digitalis in a newborn with WPW-syndrome. J Pediatr 1982; 101: 400–3

    PubMed  Article  CAS  Google Scholar 

  43. Mehta AV, Balasubrahmanyam C. Efficacy and safety of intravenous and oral nadolol for supraventricular tachycardia in children. J Am Coll Cardiol 1992; 19: 630–5

    PubMed  Article  CAS  Google Scholar 

  44. Trippel DL, Gillette PC. Atenolol in children with supraventricular tachycardia. Am J Cardiol 1989; 64: 233–6

    PubMed  Article  CAS  Google Scholar 

  45. Mehta AV, Subrahmanyan AE, Anand R. Long-term efficacy and safety of atenolol for supraventricular tachycardia in children. Pediatr Cardiol 1996; 17: 231–6

    PubMed  Article  CAS  Google Scholar 

  46. Lemler MS, Schaffer MS. Neonatal supraventricular tachycardia: predictors of successful treatment withdrawal. Am Heart J 1997; 133: 130–1

    PubMed  Article  CAS  Google Scholar 

  47. Janousek J, Paul T, Reimer A, et al. Usefulness of propafenone for supraventricular arrhythmias in infants and children. Am J Cardiol 1993; 72: 294–300

    PubMed  Article  CAS  Google Scholar 

  48. Maragnes P, Tipple M, Fournier A. Effectiveness of oral Sotalol for treatment of pediatric dysrhythmias. Am J Cardiol 1992; 69: 751–4

    PubMed  Article  CAS  Google Scholar 

  49. Tipple M, Sandor G. Efficacy and safety of oral Sotalol in early infancy. PACE 1991; 14; 2062–5

    PubMed  Article  CAS  Google Scholar 

  50. Kugler JD, Danford DA. Management of infants, children and adolescents with paroxysmal supraventricular tachycardia. J Pediatr 1996; 129: 324–38

    PubMed  Article  CAS  Google Scholar 

  51. Guccione P, Paul T, Garson A. Long-term follow-up of amio-darone therapy in the young: continued efficacy, unimpaired growth, moderate side effects. J Am Coll Cardiol 1990; 15: 1118–24

    PubMed  Article  CAS  Google Scholar 

  52. Coumel P, Fidelle J. Amiodarone in the treatment of cardiac arrhythmias in children: 135 cases. Am Heart J 1980; 100: 1063–9

    PubMed  Article  CAS  Google Scholar 

  53. Garson A, Gillette PC, McVey P, et al. Amiodarone treatment of critical arrhythmias in children and young adults. J Am Coll Cardiol 1984; 4: 749–55

    PubMed  Article  Google Scholar 

  54. Bucknall CA, Keeton BR, Curry PVL, et al. Intravenous and oral amiodarone for arrhythmias in children. Br Heart J 1986; 56: 278–84

    PubMed  Article  CAS  Google Scholar 

  55. Villain E, Bonnet D, Iserin P, et al. Current management of reentrant supraventricular tachycardia in infants [abstract]. Eur Heart J 1997; 18 Suppl.: 476

    Google Scholar 

  56. Garson A. Dosing the newer antiarrhythmic drugs in children: consideration in pediatric pharmacology. Am J Cardiol 1986; 57: 1405–7

    PubMed  Article  Google Scholar 

  57. Schaffer MS, Silka MJ, Ross BA, et al. Inadvertent atrioventricular block during radiofrequency catheter ablation. Circulation 1996; 94: 3214–20

    PubMed  Article  CAS  Google Scholar 

  58. Kugler JD, Danford DA, Ceal BJ, et al. Radiofrequency catheter ablation for tachyarrhythmias in children and adolescents. N Engl J Med 1994; 330: 1481–7

    PubMed  Article  CAS  Google Scholar 

  59. Johnson TB, Varney FL, Gillette PC, et al. Lack of proarrhythmia as assessed by Holter monitor after atrial radio frequency ablation of supraventricular tachycardia in children. Am Heart J 1996; 132: 120–4

    PubMed  Article  CAS  Google Scholar 

  60. Kugler JD. Radiofrequency catheter ablation for supraventricular tachycardia: should it be used in infants and small children? Circulation 1994; 90: 639–41

    PubMed  Article  CAS  Google Scholar 

  61. Van Hare GF. Indications for radiofrequency ablation in the pediatric population. J Cardiovasc Electrophysiol 1997; 8: 952–62

    PubMed  Article  Google Scholar 

  62. Saul JP, Hülse JE, Walsh EF. Late enlargement of radiofrequency lesions in infant lambs: implications for ablation procedures in small children. Circulation 1994; 90: 492–9

    PubMed  Article  CAS  Google Scholar 

  63. Paul T, Bokenkamp R, Mahnert B, et al. Coronary artery involvement early and late after radiofrequency current application in young pigs. Am Heart J 1997; 133: 436–40

    PubMed  Article  CAS  Google Scholar 

  64. Casey FA, McCrindle BW, Hamilton RM, et al. Neonatal atrial flutter: significant early morbidity and excellent long term prognosis. Am Heart J 1997; 133: 302–6

    PubMed  Article  CAS  Google Scholar 

  65. Till J, Wren C. Atrial flutter in the fetus and young infant: an association with accessory connections. Br Heart J 1992; 67: 80–3

    PubMed  Article  CAS  Google Scholar 

  66. Dunnisan A, Benson W, Benditt DG. Atrial flutter in infancy: diagnosis, clinical features and treatment. Pediatrics 1985; 75: 725–9

    Google Scholar 

  67. Villain E, Vetter VL, Garcia JM, et al. Evolving concepts in the management of congenital junctional ectopic tachycardia. Circulation 1990; 81: 1544–9

    PubMed  Article  CAS  Google Scholar 

  68. Paul T, Reimer A, Janousek J, et al. Efficacy and safety of propafenone in congenital junctional ectopic tachycardia. J Am Coll Cardiol 1992; 20: 911–4

    PubMed  Article  CAS  Google Scholar 

  69. Gillette PC, Garson A, Porter CJ, et al. Junctional ectopic tachycardia: new proposed treatment by transcatheter His ablation. Am Heart J 1983; 106: 619–23

    PubMed  Article  CAS  Google Scholar 

  70. Ticho BS, Saul JP, Hülse E, et al. Variable location of accessory pathways associated with the permanent form of junctional reciprocating tachycardia and confirmation with radiofrequency ablation. Am J Cardiol 1992; 70: 1559–64

    PubMed  Article  CAS  Google Scholar 

  71. Dorostkar P, Dick M, Serwer G, et al. Clinical course of persistent junctional reciprocating tachycardia. PACE 1993; 16: 878

    Article  Google Scholar 

  72. Smith RT, Gillette PC, Massumi A, et al. Transcatheter ablative techniques for treatment of the permanent form of junctional reciprocating tachycardia in young patients. J Am Coll Cardiol 1986; 8: 385–90

    PubMed  Article  Google Scholar 

  73. Von Bernuth G, Engelhardt W, Kramer HH, et al. Atrial automatic tachycardia in infancy and childhood. Eur Heart J 1992; 13: 1410–5

    Google Scholar 

  74. Dhala AA, Case CL, Gillette PC. Evolving strategies for managing atrial ectopic tachycardia in children. Am J Cardiol 1994; 74: 283–6

    PubMed  Article  CAS  Google Scholar 

  75. Naheed ZJ, Strasburger JF, Benson W, et al. Natural history and management strategies of automatic atrial tachycardia in children. Am J Cardiol 1995; 75: 405–7

    PubMed  Article  CAS  Google Scholar 

  76. Koike K, Hesslein PS, Finlay CD. Atrial automatic tachycardia in children. Am J Cardiol 1988; 61: 1127–30

    PubMed  Article  CAS  Google Scholar 

  77. Colloridi V, Perri C, Ventriglia F, et al. Oral Sotalol in pediatric atrial ectopic tachycardia. Am Heart J 1992; 123: 254–6

    PubMed  Article  CAS  Google Scholar 

  78. Bauersfeld U, Gow RM, Hamilton RM, et al. Treatment of atrial ectopic tachycardia in infants < 6 months old. Am Heart J 1995; 129: 1145–8

    PubMed  Article  CAS  Google Scholar 

  79. Saul JP, Walsh EP, Triedmar JK. Mechanisms and therapy of complex arrhythmias in pediatric patients. J Cardiovasc Electrophysiol 1995; 6: 1129–48

    PubMed  Article  CAS  Google Scholar 

  80. Walsh EP, Saul P, Hülse JE, et al. Transcatheter ablation of atrial ectopic tachycardia in young patients using radiofrequency current. Circulation 1992; 86: 1138–46

    PubMed  Article  CAS  Google Scholar 

  81. Fenrich AL, Perry JC, Freidman RA. Flecainide and amiodarone: combined therapy for refractory tachyarrhythmias in infancy. J Am Coll Cardiol 1995; 25: 1195–8

    PubMed  Article  Google Scholar 

  82. Pongiglione G, Strasburger JF, Deal BJ, et al. Use of amiodarone for short-term and adjuvant therapy in young patients. Am J Cardiol 1991; 68: 603–8

    PubMed  Article  CAS  Google Scholar 

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  1. Paediatric Cardiology, University Children’s Hospital, Freiburgstrasse, CH 3010, Berne, Switzerland

    Jean-Pierre Pfammatter

  2. Paediatric Cardiology, University Children’s Hospital, Zurich, Switzerland

    Urs Bauersfeld

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  1. Jean-Pierre Pfammatter
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Pfammatter, JP., Bauersfeld, U. Safety Issues in the Treatment of Paediatric Supraventricular Tachycardias. Drug-Safety 18, 345–356 (1998). https://doi.org/10.2165/00002018-199818050-00004

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Keywords

  • Adis International Limited
  • Digoxin
  • Amiodarone
  • Sotalol
  • Flecainide