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Amiodarone for pediatric resuscitation: a word of caution

Steven B Fishberger1, Robert L Hannan, Elizabeth M Welch

  • 1Division of Cardiology, Miami Children's Hospital, Miami, FL 33155, USA. steven.fishberger@mch.com

Pediatric Cardiology
|June 5, 2009
PubMed

Insights

Amiodarone is recommended for pediatric resuscitation but can worsen arrhythmias in patients with congenital long QT syndrome. This case highlights potential risks when amiodarone is used in undiagnosed long QT syndrome.

Area of Science:

  • Pediatric Cardiology
  • Clinical Electrophysiology
  • Pharmacology

Background:

  • Intravenous amiodarone is recommended for pediatric resuscitation in ventricular fibrillation or pulseless ventricular tachycardia.
  • Congenital long QT syndrome (LQTS) is a genetic disorder affecting cardiac repolarization.
  • Polymorphic ventricular tachycardia (PVT) can be a manifestation of LQTS.

Observation:

  • Two pediatric patients presented with polymorphic ventricular tachycardia.
  • These patients received intravenous amiodarone during resuscitation efforts.
  • Subsequent evaluation revealed underlying congenital long QT syndrome in both cases.

Findings:

  • Amiodarone administration was associated with polymorphic ventricular tachycardia in patients with undiagnosed congenital long QT syndrome.
  • Amiodarone is contraindicated in congenital long QT syndrome due to its potential to prolong the QT interval.
  • The drug may have exacerbated the ventricular arrhythmia in these pediatric patients.

Implications:

  • This case series underscores the critical importance of considering and diagnosing congenital long QT syndrome before administering amiodarone in pediatric resuscitation.
  • Misdiagnosis and inappropriate use of amiodarone in LQTS can lead to life-threatening arrhythmias.
  • Clinicians should exercise caution and consider alternative antiarrhythmic strategies in pediatric patients with undiagnosed polymorphic ventricular tachycardia.

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