Abu-Zeitone A, Peterson DR, Polonsky B, McNitt S, Moss AJ Efficacy of different beta-blockers in the treatment of long QT syndrome. J Am Coll Cardiol. 2014; 64:(13)1352-1358

Ackerman MJ, Priori SG, Dubin AM Beta-blocker therapy for long QT syndrome and catecholaminergic polymorphic ventricular tachycardia: Are all beta-blockers equivalent?. Heart Rhythm. 2017; 14:(1)e41-e44

Barry E, Smith SM Potentially inappropriate prescribing in children. Fam Pract. 2015; 32:(6)603-604 https://doi.org10.1093/fampra/cmv091

Bourgeois FT, Murthy S, Pinto C, Olson KL, Ioannidis JP, Mandl KD Pediatric versus adult drug trials for conditions with high pediatric disease burden. Pediatrics. 2012; 130:(2)285-292

Brugada J, Blom N, Sarquella-Brugada G Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement. Europace. 2013; 15:(9)1337-1382

Clausen H, Theophilos T, Jackno K, Babl FE Paediatric arrhythmias in the emergency department. Emerg Med J. 2012; 29:(9)732-737

Conn RL, Kearney O, Tully MP, Shields MD, Dornan T What causes prescribing errors in children? Scoping review. BMJ Open. 2019; 9:(8)

Conroy S, Choonara I, Impicciatore P Survey of unlicensed and off label drug use in paediatric wards in European countries. European Network for Drug Investigation in Children. BMJ. 2000; 320:(7227)79-82

Europace. 2018; 20:(5)731-732an

Elliott RA, Camacho E, Campbell FYork: Policy research unit in economic evaluation of health and care interventions; 2005

Ferro A Paediatric prescribing: why children are not small adults. Br J Clin Pharmacol. 2015; 79:(3)351-353

Hernández-Madrid A, Hocini M, Chen J How are arrhythmias managed in the paediatric population in Europe? Results of the European Heart Rhythm survey. Europace. 2014; 16:(12)1852-1856

Jang DH, Hoffman RS, Nelson LS A case of near-fatal flecainide overdose in a neonate successfully treated with sodium bicarbonate. J Emerg Med. 2013; 44:(4)781-783

Joint Formulary Committee. 2022. (accessed 23 June 2022)

Kaushal R, Bates DW, Landrigan C Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001; 285:(16)2114-2120

Karmegaraj B, Menon D, Prabhu MA, Vaidyanathan B Flecainide toxicity in a preterm neonate with permanent junctional reciprocating tachycardia. Ann Pediatr Cardiol. 2017; 10:(3)288-292

Keith T Prescribing for children. InnovAiT: Education and inspiration for general practice. 2015; 8:(10)599-606

Kothari DS, Skinner JR Neonatal tachycardias: an update. Arch Dis Child Fetal Neonatal Ed. 2006; 91:(2)F136-F144

Lawrenson J, Pribut H, Zuhlke L Drugs for the Paediatric Heart. Cont Med Ed. 2011; 29:(11)471-474

McComb JM Safety of antiarrhythmic drugs in children. Br Heart J. 1993; 70:(1)13-14

Catecholaminergic Polymorphic Ventricular Tachycardia. Gene Reviews. 2016. (accessed 23 June 2022)

Olde Nordkamp LR, Postema PG, Knops RE Implantable cardioverter-defibrillator harm in young patients with inherited arrhythmia syndromes: A systematic review and meta-analysis of inappropriate shocks and complications. Heart Rhythm. 2016; 13:(2)443-454

Priori SG, Blomström-Lundqvist C, Mazzanti A 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2015; 36:(41)2793-2867

Ramesh Iyer V Drug therapy considerations in arrhythmias in children. Indian Pacing Electrophysiol J. 2008; 8:(3)202-210

Salerno JC, Seslar SP Supraventricular tachycardia. Arch Pediatr Adolesc Med. 2009; 163:(3)268-274

Sekar RP Epidemiology of arrhythmias in children. Indian Pacing Electrophysiol J. 2008; 8:S8-S13

Siddoway LA Amiodarone: guidelines for use and monitoring. Am Fam Physician. 2003; 68:(11)2189-2196

Spearman AD, Williams P Supraventricular tachycardia in infancy and childhood. Pediatr Ann. 2014; 43:(11)456-460

Schwartz PJ, Crotti L, Insolia R Long-QT syndrome: from genetics to management [published correction appears in Circ Arrhythm Electrophysiol. 2012 Dec;5(6):e119–20]. Circ Arrhythm Electrophysiol. 2012; 5:(4)868-877

Till J Tachyarrhythmias. In: Daubeney PEF, Rigby Ml, Niwa K, Gatzoulis MA Oxford: Wiley-Blackwell; 2012

Turner CJ, Wren C The epidemiology of arrhythmia in infants: a population-based study. J Paediatr Child Health. 2013; 49:(4)278-281

Roses-Noguer F, Vaquer G, Marfil L Flecainide intoxication in pediatric patients with supraventricular tachycardia. Annals of Pediatric Cardiology. 2020; 13:(3)

van der Werf C, Kannankeril PJ, Sacher F Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. J Am Coll Cardiol. 2011; 57:(22)2244-2254

Vaquer G, Marfil L, Ortega J, Sabaté-Rotés A, Gran-Ipiña F, Ferran Roses-Noguer F Flecainide intoxication in pediatric patients with supraventricular tachycardia. Ann Pediatr Cardiol. 2020; 13:(3)264-266

Vaksmann G, D'Hoinne C, Lucet V, Guillaumont S Permanent junctional reciprocating tachycardia in children: a multicentre study on clinical profile and outcome. Heart. 2006; 92:101-104

Yang EH, Shah S, Criley JM Digitalis toxicity: a fading but crucial complication to recognize. Am J Med. 2012; 125:(4)337-343

Challenges prescribing antiarrhythmic medications for infants and children

02 August 2022
Volume 4 · Issue 8


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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