Abstract
Intravenous (IV) amiodarone hydrochloride has proven to be a very effective antiarrhythmic treatment option for a variety of ventricular and supraventricular arrhythmias in adults and paediatric patients. Amiodarone is known to have significant side effects and these especially include profound hypotension in animals and adults, vasodilatation, negative inotropic effects, and significant bradycardia especially when administered intravenously. Special caution is warranted in patients with decreased contractility and end-stage heart failure. We present a case of accidental amiodarone overdose in a newborn treated for atrial flutter resulting in cardiovascular collapse. The patient could be rescued by rapid initiation of VA-ECMO treatment. The patient survived without neurological damage.
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Agati S, Ciccarello G, Ocello S, Salvo D, Marcelletti C, Undar A, Mignosa C (2006) Pulsatile ECMO and VAD: a dual use of a new device in paediatric cardiac patients. ASAIO J 52(5):501–504
Auzinger GM, Scheinkestel CD (2001) Successful extracorporeal life support in a case of severe flecainide intoxication. Crit Care Med 29(4):887–890
Babatasi G, Massetti M, Verrier V, Lehoux P, Le Page O, Bruno PG, Khayat A (2001) Severe intoxication with cardiotoxic drugs: value of emergency percutaneous cardiocirculatory assistance. Arch Mal Coeur Vaiss 94(12):1386–1392
Banner W Jr, Timmons OD, Vernon DD (1994) Advances in the critical care of poisoned paediatric patients. Drug Saf 10(1):83–92
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
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
Drago F, Mazza A, Garibaldi S, Mafrici A, Santilli A, Ragonese P (1998) Isolated neonatal atrial flutter: clinical features, prognosis and therapy. G Ital Cardiol 28(4):365–368
Durward A, Guerguerian AM, Lefebvre M, Shemie SD (2003) Massive diltiazem overdose treated with extracorporeal membrane oxygenation. Pediatr Crit Care Med 4(3):372–376
Gandy J, Wonko N, Kantoch MJ (1998) Risks of intravenous amiodarone in neonates. Can J Cardiol 14(6):855–858
Haas NA, Plumpton K, Justo R, Jalali H, Pohlner P (2004) Postoperative junctional ectopic tachycardia (JET). Z Kardiol 93:371–380
Hoffmeister HM, Beyer ME, Seipel L (1997) Haemodynamic effects of antiarrhythmic compounds: intrinsic effects and autonomic modulation. Am J Cardiol 80(8A):24G–30G
Knirsch W, Kretschmar O, Vogel M, Uhlemann F, Bauersfeld U (2007) Successful treatment of atrial flutter with amiodarone in a premature neonate. Case report and literature review. Adv Neonatal Care 7(3):113–121
Kosinski EJ, Albin JB, Young E, Lewis SM, LeLand OS Jr (1984) Haemodynamic effects of intravenous amiodarone. J Am Coll Cardiol 4(3):565–570
Lessa MA, Tibirica E (2005) Acute cardio depressant effects induced by bolus intravenous administration of amiodarone in rabbits. Fundam Clin Pharmacol 19(2):165–172
Lisowski LA, Verheijen PM, Benatar AA, Soeyeur DJ, Stoutenbeek P, Brenner JI, Kleinman CS, Meijboom EJ (2000) Atrial flutter in the perinatal age group: diagnosis, management and outcome. J Am Coll Cardiol 35(3):771–777
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
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
Sachweh JS, Tiete AR, Fuchs A, Römer U, Kozlik-Feldmann R, Reichard B, Däbritz SH (2007) Efficacy of extracorporeal membrane oxygenation in a congenital heart surgery program. Clin Res Cardiol 96(4):204–210
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
Thourani VH, Kirshbom PM, Kanter KR, Simsic J, Kogon BE, Wagoner S, Dykes F, Fontenberry J, Forbess JM (2006) Venoarterial extracorporeal membrane oxygenation (VA-ECMO) in pediatric cardiac support. Ann Thorac Surg 82(1):138–144
Twidale N, Roberts-Thomson P, McRitchie RJ (1993) Comparative hemodynamic effects of amiodarone, sotalol, and d-sotalol. Am Heart J 126(1):122–129
Walker GM, McLeod K, Brown KL, Franklin O, Goldman AP, Davis CV (2003) Extracorporeal life support as a treatment of supraventricular tachycardia in infants. Pediatr Crit Care Med 4(1):52–54
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This case study was supported by hospital funding.
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Haas, N.A., Wegendt, C., Schäffler, R. et al. ECMO for cardiac rescue in a neonate with accidental amiodarone overdose. Clin Res Cardiol 97, 878–881 (2008). https://doi.org/10.1007/s00392-008-0700-7
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DOI: https://doi.org/10.1007/s00392-008-0700-7