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Ivabradine Versus Amiodarone in the Management of Postoperative Junctional Ectopic Tachycardia: A Randomized,
Balaji Arvind1, Shyam S Kothari1, Rajnish Juneja1
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Insights
Ivabradine is as effective as amiodarone for treating junctional ectopic tachycardia (JET) after pediatric cardiac surgery. Both drugs restored sinus rhythm similarly, though amiodarone offered faster rate control without adverse events in the ivabradine group.
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Pharmacology
Background:
- Junctional ectopic tachycardia (JET) is a significant postsurgical complication in children undergoing cardiac procedures.
- Amiodarone is the traditional treatment, but ivabradine has emerged as a potential alternative.
- Effective management of JET is crucial for improving patient outcomes post-cardiac surgery.
Purpose of the Study:
- To compare the efficacy of ivabradine versus amiodarone in managing postoperative JET in pediatric patients.
- To evaluate the primary endpoint of sinus rhythm restoration and secondary endpoints including time to conversion and rate control.
- To assess the safety profile of both pharmacological interventions.
Main Methods:
- An open-label randomized controlled trial involving 94 pediatric patients (age ≤18 years) with postoperative JET.
- Patients were randomized to receive either intravenous amiodarone or oral ivabradine.
- The primary outcome was the restoration of normal sinus rhythm, with secondary outcomes including time to rhythm conversion and rate control.
Main Results:
- Both amiodarone (93.5%) and ivabradine (95.8%) demonstrated high efficacy in converting JET to sinus rhythm, showing non-inferiority.
- The median time to achieve sinus rhythm was comparable between the amiodarone and ivabradine groups (21.5 vs. 22 hours).
- Amiodarone showed a significantly faster time to JET rate control (7.0 vs. 8.0 hours), with no adverse events reported for ivabradine.
Conclusions:
- Oral ivabradine is a non-inferior alternative to intravenous amiodarone for converting postoperative JET to sinus rhythm in children.
- While rhythm conversion times were similar, amiodarone provided earlier rate control.
- Ivabradine monotherapy presents a viable alternative to amiodarone for managing pediatric postoperative JET, particularly given its favorable safety profile.
Objectives:
This study sought to compare the efficacy of ivabradine and amiodarone in the management of postoperative junctional ectopic tachycardia (JET) after cardiac surgery in children.
Background:
JET is a serious arrhythmia occurring in children after cardiac surgery and requires aggressive management. Amiodarone has been conventionally used in its treatment. Recent studies have reported the utility of ivabradine in this regard.
Methods:
In this open-label randomized controlled trial, 94 children (age ≤18 years) who developed postoperative JET were allocated to receive either amiodarone or ivabradine. The primary endpoint was restoration of normal sinus rhythm.
Results:
Sinus rhythm was achieved in 43 out of the 46 patients (93.5%) in the amiodarone group and 46 out of the 48 patients (95.8%) in the ivabradine group (mean difference of treatment effect: 2.3%; 95% confidence interval: -6.7% to 11.5%). The median (interquartile range) time taken to achieve sinus rhythm conversion was similar in both the groups: 21.5 (17-30.2) hours versus 22 (13.4-38.5) hours (p = 0.36)]. The time taken to rate control of JET was significantly less in the amiodarone group: median 7.0 (5.5-9.5) hours versus 8.0 (5.8-10.8) hours (p = 0.02)]. No drug-related adverse events were observed in the ivabradine group.
Conclusions:
Oral ivabradine is not inferior to intravenous amiodarone in converting postoperative JET to sinus rhythm. There was no difference in time taken to sinus rhythm conversion between the groups, although the rate control was earlier in patients who received amiodarone. Monotherapy with ivabradine may be considered as an alternative to amiodarone in the management of postoperative JET. (Comparison of Two Drugs, Ivabradine and Amiodarone, in the Management of Junctional Ectopic Tachycardia, an Abnormality in Cardiac Rhythm in Patients Under 18 years Who Undergo Cardiac Surgery: CTRI/2018/08/015182).
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