Beta-adrenergic receptor antagonists and chronic heart failure in children

Chronic congestive heart failure (HF) occurs in infants and children as a result of systemic ventricle incompetence. Neurohormonal activation is thought to be the main consequence of cardiac pump failure and cause of further worsening. Several large multicenter randomized trials have demonstrated that beta-adrenergic blocking agents can improve ventricular ejection fraction, symptoms, and survival in adults with chronic congestive HF. Current literature about pediatric HF is very scarce. The only large, multicenter, randomized, placebo-controlled pediatric trial failed to demonstrate any beneficial effect of beta-blockers in infants and children with chronic HF. Other small-size reports showed significant improvement in ejection fraction and/or clinical outcomes. The HF pediatric population is characterized by wide heterogeneicity regarding causes, underlying cardiac disease, drug pharmacokinetics, and interactions, which may account for divergences. Further large-scale studies are needed to elucidate the optimal use (indications and dosages) of beta-blockers in the management of HF in children, with particular attention to the underlying cardiac disease.