Antiarrhythmic medications are the first-line treatment for most tachyarrhythmias occurring during infancy and childhood. However, there are fewer antiarrhythmic medications available to treat infants and children compared to the adult population because of licensing restrictions and the manufacture of preparations infants and children can swallow. Specially prepared antiarrhythmic medications supplied in liquid form suitable for small children are manufactured on an individual basis at a greater cost than tablet equivalents. Safety of therapy when prescribing antiarrhythmic medication includes the need for therapeutic drug monitoring and close observation to reduce adverse reactions. In addition, access to antiarrhythmic medication can be a challenge as many are deemed specialist medications and general practitioners will not assume responsibility for prescribing medications outside their product licence. These limitations and considerations can prove challenging when deciding the most suitable medication to prescribe.
This article aims to discuss the issues relating to prescribing antiarrhythmic medications for infants and children. Antiarrhythmic medications are commonly prescribed for infants (0-1 years of age) and children (1–16 years of age) experiencing benign tachyarrhythmias, such as supraventricular tachycardia (SVT), in addition to those at risk of developing life-threatening tachyarrhythmias caused by inherited cardiovascular conditions, such as long QT syndrome (LQTS) or catecholaminergic polymorphic ventricular tachycardia (CPVT) (Hernández-Madrid et al, 2014). Antiarrhythmic medications reduce the likelihood of arrhythmia occurring, limit symptomology during arrhythmia and reduce the risk of sudden death (van der Werf et al, 2011; Abu-Zeitone et al, 2014). In infancy and childhood, antiarrhythmic medications are the most favoured treatment choice as invasive procedures performed routinely on adults carry a higher risk because of the smaller size of the child and are often delayed until adolescence (Ramesh Iyer, 2008).
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