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Titolo:
SAFETY ISSUES IN THE TREATMENT OF PEDIATRIC SUPRAVENTRICULAR TACHYCARDIAS
Autore:
PFAMMATTER JP; BAUERSFELD U;
Indirizzi:
UNIV BERN,CHILDRENS HOSP,FREIBURGSTR CH-3010 BERN SWITZERLAND
Titolo Testata:
Drug safety
fascicolo: 5, volume: 18, anno: 1998,
pagine: 345 - 356
SICI:
0114-5916(1998)18:5<345:SIITTO>2.0.ZU;2-1
Fonte:
ISI
Lingua:
ENG
Soggetto:
PARKINSON-WHITE SYNDROME; ATRIAL ECTOPIC TACHYCARDIA; JUNCTIONAL RECIPROCATING TACHYCARDIA; RADIOFREQUENCY CATHETER ABLATION; TERM FOLLOW-UP; ANTIARRHYTHMIC DRUGS; PEDIATRIC-PATIENTS; YOUNG-PATIENTS; ORAL SOTALOL; VENTRICULAR-TACHYCARDIA;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
82
Recensione:
Indirizzi per estratti:
Citazione:
J.P. Pfammatter e U. Bauersfeld, "SAFETY ISSUES IN THE TREATMENT OF PEDIATRIC SUPRAVENTRICULAR TACHYCARDIAS", Drug safety, 18(5), 1998, pp. 345-356

Abstract

Paroxysmal supraventricular tachycardia caused by atrioventricular re-entry is the most frequent arrhythmia in children of all age groups. It represents the most frequent clinical situation where antiarrhythmic drug therapy has to be considered in a child. Acute termination of an episode of tachycardia in all paediatric age groups is nowadays bestachieved with an intravenous bolus injection of adenosine. Since the introduction of adenosine into clinical practice, the need to proceed to electrocardioversion has been limited to the infant (or in rare cases an older child) with severe cardiovascular collapse. In the haemodynamically stable infant or child, several other antiarrhythmic agents such as flecainide or propafenone can be used with relative safety andwith a high probability of immediate success. The same is true for verapamil, although intravenous administration should be avoided in the first year of life. In newborns and in infants with first presentationof an episode of tachycardia, drug prophylaxis of recurrences is usually recommended for the whole of the first year of life. Prophylactic treatment may consist of oral digoxin as first choice, with a beta-blocker as an alternative. In an infant with Wolff-Parkinson-White syn drome it may be wise to avoid digoxin and to start treatment with a beta-blocker. Antiarrhythmic class Ic drugs such as propafenone or flecainide, and the class III agent sotalol, are widely used as the next steps of therapy when digoxin and beta-blockers fail to prevent recurrences. These agents are about equivalent with regard to their efficacy andrisk profile. Amiodarone is considered to be an agent that should be reserved for use in situations when the tachycardia is refractory to the previously named agents. Older children may commence treatment witha beta-blocker and the subsequent steps of treatment are the same as those for infants. Curative catheter ablation of accessory pathways has been shown to be as efficient and well tolerated in the paediatric age group as it is in adults. This treatment option is nowadays quite often offered to older children. However, in infants and smaller children, ablation is used as a last resort. Rare forms of paediatric supraventricular tachycardia (other than atrioventricular re-entry through the atrioventricular node or accessory pathways) are occasionally difficult to treat and present special problems. For each of these arrhythmias, a specially tailored individual therapeutic approach is needed.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/11/20 alle ore 04:39:22