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[Amiodarone for long term treatment of arrhythmia in children]
W Rokicki1, J Durmała, E Nowakowska
1Kliniki Kardiologii Dzieciecej Slaskiej Akademii Medycznej w Katowicach.
Insights
Amiodarone effectively treats pediatric tachyarrhythmias, including life-threatening cases, with high success rates. However, careful medical monitoring is crucial due to potential side effects like thyroid issues and corneal deposits.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Tachyarrhythmias pose significant risks in pediatric patients.
- Effective long-term antiarrhythmic therapy is essential for this population.
Purpose of the Study:
- To evaluate the efficacy and safety of amiodarone for treating various tachyarrhythmias in pediatric subjects.
- To determine appropriate dosing and identify potential adverse effects.
Main Methods:
- Retrospective analysis of 37 pediatric patients (1 day to 16 years) treated with amiodarone.
- Dosing regimens included intravenous and oral administration for saturation and maintenance.
- Adverse events and treatment outcomes were systematically recorded.
Main Results:
- Amiodarone demonstrated high efficacy in treating supraventricular and ventricular tachyarrhythmias, including complex and life-threatening types.
- Normal heart rhythm was achieved in most cases, or the frequency and duration of tachycardia attacks were reduced.
- Adverse effects were observed in 24% of subjects, including thyroid dysfunction, corneal deposits, lung fibrosis, and photosensitivity, leading to treatment discontinuation in 19%.
Conclusions:
- Amiodarone is a highly effective antiarrhythmic medication for pediatric patients, even in the youngest age groups.
- Long-term treatment requires vigilant medical supervision due to the significant incidence of side effects.
Abstract:
Amiodarone was used in 37 pediatric subjects aging 1 day--16 years. Very high efficiency of long-term treatment (mean 8 months) was found in the cases of supraventricular as well as ventricular tachyarrhythmias (paroxysmal and nonparoxysmal) including complex life-threatening ones. The treatment was not effective only in three subjects. In the other cases normal heart rhythm was achieved or duration time and number of tachycardia attacks was reduced. The class of arrhythmia improved. It was often recommended to use amiodarone together with digitalis preparation in order to obtain its antiarrhythmic activity. Our usual amiodarone dose was 10-20 mg/kg of body mass/24 h intravenously (in order to interrupt the attack) or 10 mg/kg/24 h per os in saturation period. Then the daily dose was reduced to the mean equal 5 mg/kg. Amiodarone side effects were observed in rather high percentage of subjects (24%) during long-term treatment. There were abnormal laboratory tests or laboratory and clinical abnormalities of thyroid function observed in 3 cases. In 4 other ones amiodarone deposits in cornea were found. They disappeared in 2 cases after drug dose reduction. In 1 child the symptoms of lung fibrosis and in the other one of sunshine hypersensitivity were observed. Thus, because of side effects treatment had to be interrupted in 7 cases (19%). It is concluded that amiodarone is exceptionally effective antiarrhythmic drug, very useful also in the youngest pediatric patients. On the other hand it is concluded, that the treated subjects must remain under careful medical control because of high rate of amiodarone side effects.