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[Emergency treatment of arrhythmias in neonates and infants]
Insights
Propafenone effectively treated cardiac arrhythmias in infants and newborns, proving more successful than digitalization for these young patients. This study highlights Propafenone
Area of Science:
- Pediatric Cardiology
- Cardiac Electrophysiology
- Pharmacology
Context:
- Cardiac arrhythmias pose significant risks in newborns and infants.
- Traditional treatments like digitalization may have limitations in this population.
- Electrophysiological studies are crucial for diagnosing and managing pediatric arrhythmias.
Purpose:
- To evaluate the efficacy of emergency treatments for cardiac arrhythmias in infants and newborns.
- To compare the effectiveness of Propafenone and digitalization in managing pediatric arrhythmias.
- To assess the long-term outcomes of antiarrhythmic therapy in this age group.
Summary:
- This study involved 41 infants and newborns treated for cardiac arrhythmias, with 65.8% having heart defects.
- Overdrive pacing and intravenous Propafenone were effective in managing tachyarrhythmias and bradyarrhythmias.
- Oral Propafenone showed sustained efficacy with no relapses in a 1.9-year follow-up, outperforming digitalization for most cases.
Impact:
- Propafenone emerges as a highly effective antiarrhythmic agent for pediatric arrhythmias, offering a superior alternative to digitalization.
- The findings support the use of Propafenone in managing complex arrhythmias in neonates and infants.
- This research provides valuable insights for clinical decision-making in pediatric cardiac emergency care.
Abstract:
Emergency treatment of cardiac arrhythmias was required in 41 newborn and infants aged two days to 9 months (mean 77 days) from July 1977 until September 1981. Heart defects were present in 27 (65.8%). Invasive electrophysiological studies were performed in all patients. The different types of arrhythmias were: bradyarrhythmias in 9 (21.9%): bradycardia to cardiac arrest (5), congenital complete AV-block (3), postoperative complete AV-block (1). Tachyarrhythmias in 32 patients (78.1%): reentry through accessory connections (21), congenital atrial flutter (6), ventricular flutter/fibrillation (3), and AV-nodal tachycardia (2). Overdrive atrial or ventricular stimulation with a consecutive series of 15-20 impulses of 5-10 Volts abolished arrhythmic attacks in 22 patients including 4 in whom prior digitalization had no effect. In two other patients overdrive pacing achieved sinus rhythm only after i.v. Propafenon. In 4 further patients 36.2 to 63.8 mg/m2 i.v. Propafenon and in 4 other patients DC synchronized cardioversion with 1 to 3 Wsec/kg restored a normal heart rate. The 3 patients with congenital complete heart block died, one despite permanent pacing. Oral Propafenon therapy with 300 mg/m2 die in three divided doses following emergency therapy of tachyarrhythmias was discontinued in patients without arrhythmias after 1 year on drug therapy. There was no relapse after a mean follow-up period of 1.9 years. Only patients with congestive heart failure due to cardiac defects needed additional digitalisation. Thus, in our experience antiarrhythmic drug therapy with Propafenon was more effective in this age group than digitalization.