[Limited indications for glycoside therapy in pediatrics?]

Owing to its positive inotropic action, digitalis is indicated in congestive heart failure; because of its effect on AV conduction it can also be used in arrhythmias. However the nature of the dysrhythmia and the underlying causes of congestive heart failure and arrhythmia need to be further differentiated. Any underlying disease (e.g. renal failure) must be treated primarily. Also, the value of inotropic agents in obstructive lesions needs to be considered. In cardiac arrhythmias digitalis can elicit potentially dangerous arrhythmias owing to AV block. Shortening of the refractory period of "bypass tracts" and by changing automaticity in autonomic focus atrial tachycardia. The possibility of interactions with such commonly used antiarrhythmic drugs as quinidine and amiodarone must be considered. All patients receiving digitalis should be carefully followed and monitored using physical examination, ECG, echocardiographic assessments and digitalis blood level determinations.