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[Sotalol-induced torsade de pointes tachycardia in a 15-month-old infant]
1Abteilung Kinderheilkunde III und Pädiatrische Kardiologie Kinderklinik Medizinische Hochschule Hannover.
Insights
Torsade de pointes (TdP) is a rare ventricular tachycardia in children. This case study shows TdP in a child treated with sotalol, successfully managed with magnesium aspartate.
Area of Science:
- Pediatric Cardiology
- Clinical Electrophysiology
- Pharmacology
Background:
- Torsade de pointes (TdP) is a rare but serious ventricular arrhythmia.
- Sotalol is associated with TdP in adults, but pediatric cases are unreported.
- Wolff-Parkinson-White syndrome can predispose to arrhythmias.
Observation:
- A 15-month-old girl with Wolff-Parkinson-White syndrome presented with recurrent syncope.
- She was treated with sotalol since infancy for paroxysmal supraventricular tachycardia.
- Electrocardiogram revealed frequent TdP tachycardia despite normal electrolytes and no structural heart disease.
Findings:
- Discontinuation of sotalol and lidocaine infusion did not resolve the TdP.
- Administration of magnesium aspartate successfully terminated the TdP episodes.
- The TdP was deemed a proarrhythmic effect of sotalol therapy in this pediatric patient.
Implications:
- This case highlights the potential risk of sotalol-induced TdP in pediatric patients.
- Magnesium aspartate may be an effective treatment for sotalol-related TdP.
- Further investigation into sotalol's proarrhythmic potential in children is warranted.
Abstract:
Torsade de pointes (tdp) is a form of ventricular tachycardia whose occurrence in childhood is very rare. In adults treated with sotalol (Sotalex), tdp has been reported to have an incidence of 2-4%. There have been no reports of its occurrence in children treated with sotalol. We report about a 15-month-old girl with Wolff-Parkinson-White syndrome who developed recurrent syncopal attacks. She had been treated with sotalol at 1.5 mg/kg daily since being a newborn because of recurrent episodes of paroxysmal supraventricular tachycardia. Electrocardiogram exhibited frequent tdp tachycardia. Serum electrolyte levels were normal. Echocardiography excluded a structural heart defect and showed no signs of myocardial infection. After sotalol was ceased, infusion with lidocain was started. Despite this therapy the tdp continued. Magnesium aspartate (Magnesiocard) was then administered, and this finally stopped the tdp. As no other cause was evident, tdp in this child must be judged as a proarrhythmia related to sotalol therapy.