Skip to main content

Advertisement

SpringerLink
Log in

Acute hemodynamic effects of intravenous amiodarone treatment in paediatric cardiac surgical patients

  • ORIGINAL PAPER
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Introduction

The haemodynamic response after an IV-loading dose of amiodarone followed by continuous infusion for various supraventricular and ventricular tachycardias was studied in children immediately after corrective surgery for congenital heart defects.

Methods

Observational study over a 10-year period. Seventy-one out of 2651 patients (2,885 procedures, 2,106 bypass procedures) received amiodarone therapy for newly detected postoperative tachyarrhythmias. All patients received catecholamine infusions as standard post-op therapy to support cardiac function and output. In most cases a loading dose of amiodarone was given over 1–4 h followed by a continuous infusion. Catecholamine infusion dose requirements were monitored as was heart rate, blood pressure, central venous pressure, and sedation dose requirements pre treatment and at 0.5, 1, 2, 4, 8, 12 and 24 h after the begin of the amiodarone administration.

Results

After 1 h there was a significant decrease of heart rate from 194.5 bpm (±31.9) to 157.5 bpm (±34.3) and an increase of the mean arterial blood pressure from 52.8 (±11.4) to 56.0 (±9.8) mmHg, with a subsequent decrease of filling pressures. The catecholamine dose required could be decreased as could the dose for sedation. Rate control was achieved at 277.4 min (±344) and rhythm control at 685.8 min (±988.5) respectively. Based on a preliminary interim analysis a specific treatment protocol was established and used in 32 patients.

Conclusion

A slow bolus administration of 5 mg/kg amiodarone over at least 60 min followed by one or two additional boluses or a continuous infusion with 10–20 mg/kg day−1 is a safe treatment strategy without the need for additional inotropic support and with dramatic improvement of heart rate, blood pressure and filling pressures. This protocol can be recommended for paediatric patients in the early postoperative setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. American Heart Association (2005) 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support. Circulation. 112(24 Suppl):IV1–IV203

    Google Scholar 

  2. Bouillon T, Schiffmann H, Bartmus D, Gundert-Remy U (1996) Amiodarone in a newborn with ventricular tachycardia and an intracardiac tumor: adjusting the dose according to an individualized dosing regimen. Pediatr Cardiol 17(2):112–114

    Article  PubMed  CAS  Google Scholar 

  3. Bucknall CA, Keeton BR, Curry PV, Tynan MJ, Sutherland GR, Holt DW (1986) Intravenous and oral amiodarone for arrhythmias in children. Br Heart J 56(3):278–284

    Article  PubMed  CAS  Google Scholar 

  4. Burri S, Hug MI, Bauersfeld U (2003) Efficacy and safety of intravenous amiodarone for incessant tachycardias in infants. Eur J Pediatr 162(12):880–884

    Article  PubMed  CAS  Google Scholar 

  5. Cabrera Duro A, Rodrigo Carbonero D, Galdeano Miranda JM, Martinez Corrales P, Pastor Menchaca E, Macua Biurrun P, Pilar Orive J (2002) The treatment of postoperative junctional ectopic tachycardia. An Esp Pediatr 56(6):505–509

    PubMed  CAS  Google Scholar 

  6. Celiker A, Ceviz N, Ozme S (1998) Effectiveness and safety of intravenous amiodarone in drug-resistant tachyarrhythmias of children. Acta Paediatr Jpn 40(6):567–572

    PubMed  CAS  Google Scholar 

  7. Celiker A, Kocak G, Lenk MK, Alehan D, Ozme S (1997) Short- and intermediate-term efficacy of amiodarone in infants and children with cardiac arrhythmia. Turk J Pediatr 39(2):219–225

    PubMed  CAS  Google Scholar 

  8. Cheung AT, Weiss SJ, Savino JS, Levy WJ, Augoustides JG, Harrington A, Gardner TJ (2003) Acute circulatory actions of intravenous amiodarone loading in cardiac surgical patients. Ann Thorac Surg 76(2):535–541

    Article  PubMed  Google Scholar 

  9. Clemo HF, Wood MA, Gilligan DM, Ellenbogen KA (1998) Intravenous amiodarone for acute heart rate control in the critically ill patient with atrial tachyarrhythmias. Am J Cardiol 81(5):594–598

    Article  PubMed  CAS  Google Scholar 

  10. Daniels CJ, Schutte DA, Hammond S, Franklin WH (1997) Acute pulmonary toxicity in an infant from intravenous amiodarone. Am J Cardiol 80(8):1113–1116

    Article  PubMed  CAS  Google Scholar 

  11. Dodge-Khatami A, Miller OI, Anderson RH, Gil-Jaurena JM, Goldman AP, de Leval MR (2002) Impact of junctional ectopic tachycardia on postoperative morbidity following repair of congenital heart defects. Eur J Cardiothorac Surg 21(2):255–259

    Article  PubMed  CAS  Google Scholar 

  12. Drago F, Mazza A, Guccione P, Mafrici A, Di Liso G, Ragonese P (1998) Amiodarone used alone or in combination with propranolol: a very effective therapy for tachyarrhythmias in infants and children. Pediatr Cardiol 19(6):445–449

    Article  PubMed  CAS  Google Scholar 

  13. Etheridge SP, Craig JE, Compton SJ (2001) Amiodarone is safe and highly effective therapy for supraventricular tachycardia in infants. Am Heart J 141(1):105–110

    Article  PubMed  CAS  Google Scholar 

  14. Fenrich AL Jr, Perry JC, Friedman RA (1995) Flecainide and amiodarone: combined therapy for refractory tachyarrhythmias in infancy. J Am Coll Cardiol 25(5):1195–1198

    Article  PubMed  Google Scholar 

  15. Figa FH, Gow RM, Hamilton RM, Freedom RM (1994) Clinical efficacy and safety of intravenous amiodarone in infants and children. Am J Cardiol 74(6):573–7

    Article  PubMed  CAS  Google Scholar 

  16. Gandy J, Wonko N, Kantouch MJ (1998) Risks of intravenous amiodarone ion neonates. Can J Cardiol 14(6):855–858

    PubMed  CAS  Google Scholar 

  17. Garson A Jr, Gillette PC, McVey P, Hesslein PS, Porter CJ, Angell LK, Kaldis LC, Hittner HM (1984) Amiodarone treatment of critical arrhythmias in children and young adults. J Am Coll Cardiol 4(4):749–755

    PubMed  Google Scholar 

  18. Guccione P, Paul T, Garson A Jr (1990). Long-term follow-up of amiodarone therapy in the young: continued efficacy, unimpaired growth, moderate side effects. J Am Coll Cardiol 15(5):1118–1124

    PubMed  CAS  Google Scholar 

  19. Haas NA, Fox S, Skinner JR (2005) Successful use of an intravenous infusion of flecainide and amiodarone for a refractory combination of postoperative junctional and ectopic tachycardias. Cardiol Young 15(4):427–430

    Article  PubMed  Google Scholar 

  20. Haas NA, Plumpton K, Justo R, Jalali H, Pohlner P (2004) Postoperative junctional ectopic tachycardia (JET). Z Kardiol 93:371–380

    Article  PubMed  CAS  Google Scholar 

  21. Hijazi ZM, Rosenfeld LE, Copel JA, Kleinman CS (1992) Amiodarone therapy of intractable atrial flutter in a premature hydropic neonate. Pediatr Cardiol 13(4):227–229

    Article  PubMed  CAS  Google Scholar 

  22. Hoffman TM, Bush DM, Wernovsky G, Cohen MI, Wieand TS, Gaynor JW, Spray TL, Rhodes LA (2002) Postoperative junctional ectopic tachycardia in children: incidence, risk factors, and treatment. Ann Thorac Surg 74(5):1607–1611

    Article  PubMed  Google Scholar 

  23. Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, Bailey JM, Akbary A, Kocsis JF, Kaczmarek R, Spray TL, Wessel DL (2003) Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 107(7):996–1002

    Article  PubMed  CAS  Google Scholar 

  24. Hoffman TM, Wernovsky G, Wieand TS, Cohen MI, Jennings AC, Vetter VL, Godinez RI, Gaynor JW, Spray TL, Rhodes LA (2002) The incidence of arrhythmias in a pediatric cardiac intensive care unit. Pediatr Cardiol 23(6):598–604

    Article  PubMed  CAS  Google Scholar 

  25. Hoffmeister HM, Beyer ME, Seipel L (1997) Hemodynamic effects of antiarrhythmic compounds: intrinsic effects and autonomic modulation. Am J Cardiol 80(8A):24G–30G

    Article  PubMed  CAS  Google Scholar 

  26. Holt AW (1989) Hemodynamic responses to amiodarone in critically ill patients receiving catecholamine infusions. Crit Care Med 17(12):1270–1276

    PubMed  CAS  Google Scholar 

  27. International Liaison Committee on Resuscitation (2005) 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6: Paediatric basic and advanced life support. Resuscitation. 67(2–3):271–91

    Google Scholar 

  28. Kosinski EJ, Albin JB, Young E, Lewis SM, LeLand OS Jr (1984) Hemodynamic effects of intravenous amiodarone. J Am Coll Cardiol 4(3):565–570

    PubMed  CAS  Google Scholar 

  29. Kuo CS, Reddy CP, Paciotti MV (1985) Asystole during treatment with amiodarone in a patient with persistent atrial tachycardia. J Electrocardiol 18(1):105–109

    Article  PubMed  CAS  Google Scholar 

  30. Laird WP, Snyder CS, Kertesz NJ, Friedman RA, Miller D, Fenrich AL (2003) Use of intravenous amiodarone for postoperative junctional ectopic tachycardia in children. Pediatr Cardiol 24(2):133–137

    Article  PubMed  CAS  Google Scholar 

  31. Lessa MA, Tibirica E (2005) Acute cardiodepressant effects induced by bolus intravenous administration of amiodarone in rabbits. Fundam Clin Pharmacol 19(2):165–172

    Article  PubMed  CAS  Google Scholar 

  32. Martinez EA, Bass EB, Zimetbaum P (2005) American College of Chest Physicians. Pharmacologic control of rhythm: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 128(2 Suppl):48S–55S

    Article  PubMed  CAS  Google Scholar 

  33. Martinez EA, Epstein AE, Bass EB (2005) American College of Chest Physicians Pharmacologic control of ventricular rate: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 128(2 Suppl):56S–60S

    Article  PubMed  CAS  Google Scholar 

  34. Mazic U, Berden P, Podnar T (2004) Repetitive paroxysms of supraventricular tachyarrhythmias triggered during pediatric cardiac interventions: suppression after short infusion of amiodarone. Pediatr Cardiol 25(6):684–685

    Article  PubMed  CAS  Google Scholar 

  35. McGovern B, Garan H, Kelly E, Ruskin JN (1983) Adverse reactions during treatment with amiodarone hydrochloride. Br Med J (Clin Res Ed) 287(6386):175–180

    CAS  Google Scholar 

  36. McGovern B, Garan H, Ruskin JN (1982) Sinus arrest during treatment with amiodarone. Br Med J (Clin Res Ed) 284(6310):160–161

    Article  CAS  Google Scholar 

  37. McMahon CJ, Laird WP, Fenrich AL (2003) Amiodarone-induced 2 to 1 atrioventricular block in association with prolongation of the QT interval. Cardiol Young 13(3):305–307

    PubMed  Google Scholar 

  38. Michael JG, Wilson WR Jr, Tobias JD (1999) Amiodarone in the treatment of junctional ectopic tachycardia after cardiac surgery in children: report of two cases and review of the literature. Am J Ther 6(4):223–227

    Article  PubMed  CAS  Google Scholar 

  39. Ng GY, Hampson Evans DC, Murdoch LJ (2003) Cardiovascular collapse after amiodarone administration in neonatal supraventicular tachycardia. Eur J Emerg Med 10(4):323–325

    Article  PubMed  Google Scholar 

  40. Paul T, Guccione P (1994) New antiarrhythmic drugs in pediatric use: amiodarone. Pediatr Cardiol 15(3):132–138

    PubMed  CAS  Google Scholar 

  41. Perry JC, Fenrich AL, Hulse JE, Triedman JK, Friedman RA, Lamberti JJ (1996) Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol. J Am Coll Cardiol 27(5):1246–1250

    Article  PubMed  CAS  Google Scholar 

  42. Perry JC, Knilans TK, Marlow D, Denfield SW, Fenrich AL, Friedman RA (1993) Intravenous amiodarone for life-threatening tachyarrhythmias in children and young adults. J Am Coll Cardiol 22(1):95–98

    Article  PubMed  CAS  Google Scholar 

  43. Plumpton K, Justo R, Haas N (2005) Amiodarone for post-operative junctional ectopic tachycardia. Cardiol Young 15(1):13–18

    Article  PubMed  Google Scholar 

  44. Pohlgeers A, Villafane J (1995) Ventricular fibrillation in two infants treated with amiodarone hydrochloride. Pediatr Cardiol 16(2):82–84

    Article  PubMed  CAS  Google Scholar 

  45. Raja P, Hawker RE, Chaikitpinyo A, Cooper SG, Lau KC, Nunn GR, Cartmill TB, Sholler GF (1994) Amiodarone management of junctional ectopic tachycardia after cardiac surgery in children. Br Heart J 72(3):261–265

    Article  PubMed  CAS  Google Scholar 

  46. Saul JP, Scott WA, Brown S, Marantz P, Acevedo V, Etheridge SP, Perry JC, Triedman JK, Burriss SW, Cargo P, Graepel J, Koskelo EK, Wang R (2005) Intravenous amiodarone pediatric investigators. Intravenous amiodarone for incessant tachyarrhythmias in children: a randomized, double-blind, antiarrhythmic drug trial. Circulation 112(22):3470–3477

    Article  PubMed  CAS  Google Scholar 

  47. Singh BN (1996) Antiarrhythmic actions of amiodarone: a profile of a paradoxical agent. Am J Cardiol 78(4A):41–53

    Article  PubMed  CAS  Google Scholar 

  48. Slater A, Shann F, ANZICS Paediatric Study Group (2004) The suitability of the pediatric index of mortality (PIM), PIM2, the pediatric risk of mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand. Pediatr Crit Care Med 5(5):447–454

    Google Scholar 

  49. Soult JA, Munoz M, Lopez JD, Romero A, Santos J, Tovaruela A (1995) Efficacy and safety of intravenous amiodarone for short-term treatment of paroxysmal supraventricular tachycardia in children. Pediatr Cardiol 16(1):16–19

    Article  PubMed  CAS  Google Scholar 

  50. Till JA, Baxendall M, Benetar A (1993) Acceleration of the ventricular response to atrial flutter by amiodarone in an infant with Wolff–Parkinson-White syndrome. Br Heart J 70(1):84–87

    Article  PubMed  CAS  Google Scholar 

  51. Twidale N, Roberts-Thomson P, McRitchie RJ (1993) Comparative hemodynamic effects of amiodarone, sotalol, and d-sotalol. Am Heart J 126(1):122–129

    Article  PubMed  CAS  Google Scholar 

  52. Uebing A, Stieh J, Jung O, Kramer HH, Oldigs HD (1998) Atrial ectopic tachycardia in infancy caused by tumor of the interatrial septum. Z Kardiol 87(6):478–481

    Article  PubMed  CAS  Google Scholar 

  53. Vaksmann G, D’Hoinne C, Lucet V, Guillaumont S, Lupoglazoff JM, Chantepie A, Denjoy I, Villain E, Marcon F (2006) Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome. Heart 92(1):101–104

    Article  PubMed  CAS  Google Scholar 

  54. Valsangiacomo E, Schmid ER, Schupbach RW, Schmidlin D, Molinari L, Waldvogel K, Bauersfeld U (2002) Early postoperative arrhythmias after cardiac operation in children. Ann Thorac Surg 74(3):792–796

    Article  PubMed  Google Scholar 

  55. Walsh EP, Saul JP, Sholler GF, Triedman JK, Jonas RA, Mayer JE, Wessel DL (1997) Evaluation of a staged treatment protocol for rapid automatic junctional tachycardia after operation for congenital heart disease. J Am Coll Cardiol 29(5):1046–1053

    Article  PubMed  CAS  Google Scholar 

  56. Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, Walsh AZ, Chang AC, Castaneda AR, Newburger JW (1995) Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 92:2226–2235

    PubMed  CAS  Google Scholar 

  57. Wong KK, Potts JE, Etheridge SP, Sanatani S (2006) Medications used to manage supraventricular tachycardia in the infant a North American survey. Pediatr Cardiol 27(2):199–203

    Article  PubMed  CAS  Google Scholar 

  58. Yap SC, Hoomtje T, Sreeram N (2000) Polymorphic ventricular tachycardia after use of intravenous amiodarone for postoperative junctional ectopic tachycardia. Int J Cardiol 76(2–3):245–247

    Article  PubMed  CAS  Google Scholar 

  59. Yildirim SV, Azak E, Varan B, Tokel K (2005) Unusual, early hyperglycemia following amiodarone infusion in two infants. Pediatr Cardiol 26(5):715–766

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatric Cardiac Intensive Care, The Prince Charles Hospital, Brisbane, Australia

    Nikolaus A. Haas MD & Christoph K. Camphausen MD

  2. Department of Congenital Heart Defects, Paediatric Cardiac Interventions, Heart and Diabetes Centre, North-Rhine Westphalia, Georgstrasse 11, 32545, Bad Oeynhausen, Germany

    Nikolaus A. Haas MD

  3. The Department of Paediatric Cardiology, Sydney Children’s Hospital, High Street, Randwick, Sydney, NSW, 2031, Australia

    Christoph K. Camphausen MD

Authors
  1. Nikolaus A. Haas MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christoph K. Camphausen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nikolaus A. Haas MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Haas, N.A., Camphausen, C.K. Acute hemodynamic effects of intravenous amiodarone treatment in paediatric cardiac surgical patients. Clin Res Cardiol 97, 801–810 (2008). https://doi.org/10.1007/s00392-008-0683-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-008-0683-4

Keywords

Search

Navigation