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[Our experience with flecainide acetate in resistant arrhythmias in children. Apropos of 35 cases]
1Centre de cardiologie infantile du Château des Côtes, Les Loges-en-Josas.
Insights
Flecainide acetate effectively treated pediatric junctional tachycardia, including Wolff-Parkinson-White syndrome, in most patients. This antiarrhythmic drug demonstrated ease of use and is a preferred option for pediatric cardiac arrhythmia management.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
- Cardiac Electrophysiology
Context:
- Pediatric cardiac arrhythmias, particularly junctional tachycardia, pose significant management challenges.
- Resistant forms of tachycardia often require effective and safe pharmacological interventions.
- Wolff-Parkinson-White syndrome and intranodal reentry are common causes of pediatric supraventricular tachycardias.
Purpose:
- To evaluate the efficacy and safety of flecainide acetate in pediatric patients with resistant cardiac arrhythmias.
- To determine the optimal dosing and therapeutic plasma concentrations of flecainide acetate in children.
- To assess the impact of flecainide acetate on electrophysiological parameters like QRS duration and preexcitation.
Summary:
- Thirty-five pediatric patients with various junctional tachycardias received flecainide acetate, achieving complete suppression in 24 cases and partial success in 4.
- Treatment efficacy was linked to plasma concentrations, with higher ratios observed in infants, suggesting age-dependent drug metabolism.
- Flecainide acetate administration was straightforward, with minimal extracardiac side effects reported, and it significantly increased QRS duration in treated patients.
Impact:
- Flecainide acetate emerges as a valuable and effective therapeutic option for managing pediatric junctional tachycardia.
- Understanding age-related pharmacokinetic differences is crucial for optimizing flecainide dosing in neonates and infants.
- The study supports flecainide acetate as a drug of choice, simplifying treatment protocols for pediatric arrhythmias.
Abstract:
Thirty-five patients aged 6 days to 18 years (average 7.5 +/- 5.2 years) were treated for an average period of 16 months (range 8 days to 50 months) with flecainide acetate at an average dose of 4.8 +/- 1.4 mg/kg (2.9 to 10 mg/kg) or 130 +/- 30.5 mg/m2 administered twice daily. The cardiac arrhythmia was a resistant paroxysmal junctional tachycardia due to a Wolff-Parkinson-White syndrome in 27 cases, intranodal reentry in 6 cases and a chronic reciprocating rhythm in 2 cases. Treatment was successful with complete suppression of the tachycardia in 24 cases. Partial success with a good clinical result was obtained in 4 cases and there were 7 failures, 6 due to inefficacy of the drug, and 1 because of an extracardiac secondary effect. One case of incessant junctional tachycardia was observed in a 9 month old child in whom the preexcitation disappeared. Atrioventricular preexcitation persisted in 20 out of 24 cases. The duration of the non-preexcited QRS complexes increased significantly from 73.6 +/- 13.8 to 82.2 +/- 15.2 ms; n = 14, p less than 0.01. The minimal effective plasma concentration was 347 +/- 147 ng/ml. The plasma concentration/dose ratio of children over 4 years of age was the same as in adults. It was significantly higher in babies and infants suggesting a progressive acquisition of the capacity to metabolise flecainide during the first year of life. In conclusion, flecainide acetate was easy to use with respect to administration and follow-up, and seems to be a drug of choice for the treatment of junctional tachycardia in children.