Ivabradine Use for Arrhythmias in Children.

Area of Science:

• Pediatric Cardiology
• Pharmacology
• Clinical Trials

Background:

• Ivabradine is a hyperpolarization-activated cyclic nucleotide-gated channel blocker.
• It is used off-label for treating arrhythmias in pediatric patients.

Purpose of the Study:

• To identify the line of therapy and arrhythmia type for initiating ivabradine in pediatric patients.
• To assess ivabradine dosing, tolerance in partially fed patients, home continuation rates, drug interactions, and adverse effects.

Main Methods:

• Retrospective study of pediatric patients (<18 years) receiving ivabradine for arrhythmias from January 2021 to November 2023.
• Data collected included demographics, dosing, concomitant medications, feeding status, drug interactions, and adverse events like bradycardia and emesis.

Main Results:

• Seventeen patients were included; atrial tachycardia was the most common indication.
• Ivabradine was typically a third-line therapy, with 58.8% initiated on partial enteral feeds.
• Median initial and peak doses were 0.05 and 0.07 mg/kg/dose, respectively; 94.1% had Class C drug-drug interactions.
• 58.8% were discharged home on ivabradine, with only one dose decrease due to adverse effects.

Conclusions:

• Ivabradine demonstrated safety and efficacy as an add-on therapy for pediatric arrhythmias.
• Larger studies are warranted to further investigate ivabradine's role in pediatric arrhythmia management.