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A scoping review of the evidence supporting antiarrhythmic use after paediatric cardiac surgery
Rebecca D Sullenger1, Taylor Kohlmann1,2, Alison G Kilborn2
1Duke University School of Medicine, Durham, NC, USA.
Insights
Limited evidence supports antiarrhythmic drug use in pediatric cardiac surgery patients. More randomized trials with standardized outcomes are needed to guide safe and effective treatment for post-operative arrhythmias.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Pharmacology
Background:
- Arrhythmias are common after pediatric cardiac surgery, increasing morbidity and mortality.
- Limited data exists on the safety and efficacy of antiarrhythmic drugs in this patient group.
Purpose of the Study:
- To systematically review the literature on antiarrhythmic drug use in children under 18 following cardiac surgery.
- To assess the available evidence regarding the safety and efficacy of commonly used antiarrhythmics.
Main Methods:
- A systematic literature search was conducted in PubMed and EMBASE (2000-2024).
- Two reviewers screened abstracts and full-text articles for eligibility.
- Studies involving 11 different antiarrhythmics in pediatric patients post-cardiac surgery were included.
Main Results:
- 28 studies involving 3,752 patients were identified, covering 11 antiarrhythmic agents.
- Most studies were small, with limited randomization and varied safety/efficacy endpoints.
- Overall evidence supporting the use of these drugs in this population was found to be limited.
Conclusions:
- Randomized trials with standardized endpoints are lacking for antiarrhythmic therapy in pediatric cardiac surgery.
- Pragmatic trials generating real-world data are recommended to evaluate antiarrhythmic safety and efficacy.
- Further research is crucial to guide optimal antiarrhythmic selection in pediatric patients post-cardiac surgery.
Background:
Arrhythmias after paediatric cardiac surgery occur frequently and contribute to postoperative morbidity and mortality. There is limited literature assessing the safety and efficacy of common antiarrhythmics administered in this population.
Methods:
We systematically searched PubMed and EMBASE for literature on antiarrhythmic use in children <18 years of age after cardiac surgery from 2000 to 2024. Two reviewers independently screened abstracts and then reviewed full-text manuscripts to determine eligibility.
Results:
We identified 28 studies of 3,752 patients across 11 different antiarrhythmics: flecainide, procainamide, esmolol, landiolol, propranolol, amiodarone, sotalol, dexmedetomidine, digoxin, ivabradine, and magnesium. Most studies were small, with 17 enrolling fewer than 100 children. Only eight studies were randomised, 16 were retrospective, 12 were prospective, and one was multicenter. Safety and efficacy endpoints varied widely, limiting our ability to combine data for meta-analysis. Overall, evidence supporting the use of these drugs in children after cardiac surgery was limited.
Conclusion:
Although antiarrhythmics are commonly used in children after cardiac surgery, randomised trials with standardised endpoints to guide choice of therapy are lacking. Pragmatic trials to generate real-world data should be considered to further evaluate the safety and efficacy of various antiarrhythmics in this population.
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