Accelerated idioventricular rhythm associated with propranolol treatment in a child

Area of Science:

• Pediatric Cardiology
• Clinical Electrophysiology
• Pharmacology

Background:

• Accelerated idioventricular rhythm (AIVR) is a ventricular arrhythmia typically associated with adult cardiac disease.
• Differentiating AIVR from life-threatening ventricular tachycardia is crucial for patient management.
• The etiology of AIVR in pediatric populations, especially in otherwise healthy individuals, requires further investigation.

Observation:

• A case study involving a healthy child experiencing episodes of AIVR.
• The AIVR episodes were temporally associated with the administration of propranolol.
• Continuous 24-hour electrocardiography monitoring revealed distinct differences between sinus and ventricular beats during AIVR.

Findings:

• The child presented with accelerated idioventricular rhythm (AIVR) during propranolol therapy.
• Electrocardiographic data confirmed the presence of AIVR, characterized by a unique rhythm distinct from the sinus rhythm.
• Resolution of AIVR occurred upon cessation of propranolol treatment, with a return to sinus rhythm.

Implications:

• This case represents the first documented instance of AIVR linked to propranolol use in a pediatric patient.
• The findings suggest a potential iatrogenic cause for AIVR in children, particularly with beta-blocker exposure.
• Further research is warranted to understand the mechanism and prevalence of propranolol-induced AIVR in pediatric cardiology.