Abstract
Amiodarone is an effective anti-arrhythmic agent for the treatment of supraventricular and ventricular tachycardias. The safety and efficacy of intravenous amiodarone has been described in adults and children but only to a limited extent in infants. The purpose of this study was to evaluate the safety and efficacy of intravenous amiodarone in infants. Between February 1994 and June 2001, 23 infants with a median age of 8 days (range 1–300 days) with life-threatening incessant tachycardias (17 supraventricular, 6 ventricular) were treated with intravenous amiodarone as single anti-arrhythmic agent. At presentation, 22 infants were haemodynamically unstable. Amiodarone was given as an intravenous loading dose of 5 mg/kg over 1 h followed by an intravenous maintenance dose of 5 µg/kg per min with stepwise increase up to 25 µg/kg per min until arrhythmia control or side-effects occurred. Amiodarone was effective in 19 infants, partially effective in three and ineffective in one infant. The median time until arrhythmia control was 24 h (range 1–96 h) and the median maintenance dosage 15 µg/kg per min (range 5–26 µg/kg per min). Electrophysiological side-effects necessitating dose reduction comprised of sinus bradycardia in two patients. Hypotension in one patient resolved after dose diminution. Neurological side-effects consisted of choreatic movements in one infant, which resolved over time. Amiodarone administration was stopped in one patient with elevated liver enzymes. Conclusion:intravenous amiodarone is a safe and effective therapy for life-threatening incessant tachycardias in infants.
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References
Coumel P, Fidelle J (1980) Amiodarone in the treatment of cardiac arrhythmias in children:one hundred and thirty five cases. Am Heart J 100: 1063–1069
Doggrell S (2001) Amiodarone – waxed and waned and waxed again. Expert Opin Pharmacother 2: 1877–1890
Etheridge S, Craig J, Compton S (2001) Amiodarone is safe and highly effective therapy for supraventricular tachycardia in infants. Am Heart J 141: 105–110
Figa F, Gow R, Hamilton R, Freedom R (1994) Clinical efficacy and safety of intravenous amiodarone in infants and children. J Am Coll Cardiol 74: 573–577
Gallik D, Singer I, Meissner M, Molnar J, Somberg J (2002) Hemodynamic and surface electrocardiographic effects of a new aqueous formulation of intravenous amiodarone. Am J Cardiol 90: 964–968
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: 1022–1027
Perry J, Fenrich A, Hulse E, Triedman J, Friedman R, Lamberti J (1996) Pediatric use of intravenous amiodarone: efficacy and safety in critically ill patients from a multicenter protocol. J Am Coll Cardiol 27: 1246–1250
Pfammatter J, Bauersfeld U (1998) Safety issues in the treatment of paediatric supraventricular tachycardias. Drug Safety 18: 345–356
Pfammatter J, Paul T (1999) Idiopathic ventricular tachycardia in infancy and childhood. J Am Coll Cardiol 33: 2067–2072
Sim I, MacDonald K, Lavori P, Norbutas C, Hlatky M (1997) Quantitative overview of randomised trials of amiodarone to prevent sudden cardiac death. Circulation 96: 2823–2829
Somberg J, Bailin S, Haffajee C, Paladino W, Kein N, Bridges D, Timar S, Molnar J (2002) Intravenous lidocain versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia. Am J Cardiol 90: 853–859
The CAPS Investigators (1986) The cardiac arrhythmia pilot study. Am J Cardiol 157: 91–95
Villain E (1997) Amiodarone as treatment for atrial tachycardias after surgery. Pace 20: 2130–2132
Yabek S, Kato R, Singh B (1985) Acute effects of amiodarone on the electrophysiologic properties of isolated neonatal and adult cardiac fibers. J Am Coll Cardiol 5: 1109–1115
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Burri, S., Hug, M.I. & Bauersfeld, U. Efficacy and safety of intravenous amiodarone for incessant tachycardias in infants. Eur J Pediatr 162, 880–884 (2003). https://doi.org/10.1007/s00431-003-1302-z
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DOI: https://doi.org/10.1007/s00431-003-1302-z