New antiarrhythmic drugs in pediatric use: amiodarone

Amiodarone, a class III antiarrhythmic agent, prolongs action potential duration and refractoriness of all cardiac structures. The drug is more rapidly metabolized in pediatric patients than in adults, but its kinetics are still unique compared with other drugs. Due to the unusual pharmacokinetic characteristics of amiodarone, treatment has to be started by administering loading doses, and there is a significant delay both in the achievement of the full anti-arrhythmic effect and in the development of side effects. Amiodarone is a highly effective agent in pediatric patients with automatic and reentrant supraventricular tachycardia as well as in refractory atrial flutter. Efficacy in ventricular tachycardia has been shown to be variable depending on the underlying anatomical substrate. The incidence of side effects is lower than that observed in adult studies with similar duration of therapy but their incidence is still significant. Amiodarone treatment is associated with a significant risk of proarrhythmic effects, requiring hospitalization of the patient during the loading period.