Interest of ivabradine in pediatric arrhythmia. About a case and review of the literature - 14/08/21
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Riassunto |
Introduction |
By inhibiting the pacemaker current if of the sinoatrial node (SN), ivabradine was first use as an alternative to betablockers in the treatment of heart failure [1]. For a few years, it has been proposed as an adjuvant therapy for postoperative [2] or congenital junctional ectopic tachycardia [3]. But ivabradine can also be effective on atrial and ventricular abnormal automaticity [4].
Case report |
We report the case of a 9 years old girl who was diagnosed of polymorphic atrial tachycardia at birth. The child was first treated by amiodarone. When amiodarone had to be withdraw because of thyroid dysfunction, multiple antiarrhythmic drugs were tested alone or in association: betablockers, flecainide, digoxine. Despite medication, the child experimented multiple high rate non-sustained tachycardia per day. After an antiarrhythmic washout, ivabradine was started. Fig. 1 is the patient Holter without any treatment showing a very anarchic rhythm, mostly rapid arrhythmia. Fig. 2 is the patient Holter after only 2 takes of ivabradine that shows a marked efficacy of the drug.
Discussion |
Ivabradine inhibits selectively the If current that is responsible of the pacemaker activity of the SN and the AV node. If current can also be responsible of abnormal automaticity of the atrial and ventricular myocardium. In such case, ivabradine is highly effective to control the arrhythmia. Still, ivabradine efficacy is difficult to predict, but regarding its overall safety, it can be tested. In a randomized, double-blind trial of pediatric patient with dilated cardiomyopathy, Bonnet et al. did not report more adverse event with ivabradine than with placebo [5].
The outcome of atrial ectopic arrhythmia in the pediatric population is good: 78% will resolve spontaneously when diagnosed under 3 years old [6]. Ivabradine could be an alternative to catheter ablation in the very young or in pediatric patient with multifocal arrhythmia or organized arrhythmia close to the AV conduction system.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Tachyarrhythmia, Abnormal automaticity, Ivabradine
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Vol 13 - N° 4
P. 312-313 - settembre 2021 Ritorno al numero
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