Nathalie Oeffl

Antiarrhythmic drugs represent a mainstay of pediatric arrhythmia treatment. However, official guidelines and consensus documents on this topic remain scarce. There are rather uniform recommendations for some medications (including adenosine, amiodarone, and esmolol), while there are only very broad dosage recommendations for others (such as sotalol or digoxin). To prevent potential uncertainties and even mistakes with regard to dosing, we summarized the published dosage recommendations for antiarrhythmic drugs in children. Because of the wide variations in availability, regulatory approval, and experience, we encourage centers to develop their own specific protocols for pediatric antiarrhythmic drug therapy.

Background: In neonates, cardiac arrhythmias are rare. Electric countershock therapy is an effective alternative to drug therapy for neonatal arrhythmias. There are no randomized controlled studies investigating electric countershock therapy in neonates. Objective: To identify all studies and publications describing electric countershock therapy (including defibrillation, cardioversion, and pacing) in newborn infants within 28 days after birth, and to provide a comprehensive review of this treatment modality and associated outcomes. Methods: For this systematic review we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). All articles reporting electric countershock therapy in newborn infants within 28 days after birth were included. Results: In terms of figures, 113 neonates who received electric countershock due to arrhythmias were reported. Atrial flutter (76.1%) was the most common arrhythmia, followed by supraventricular tachycardia (13.3%). Others were ventricular tachycardia (9.7%) and torsade de pointes (0.9%). The main type of electric countershock therapy was synchronized cardioversion (79.6%). Transesophageal pacing was used in twenty neonates (17.7%), and defibrillation was used in five neonates (4.4%). Conclusion: Electric countershock therapy is an effective treatment option in the neonatal period. In atrial flutter especially, excellent outcomes are reported with direct synchronized electric cardioversion.

We aimed to assess the accuracy of determining accessory pathway (AP) localization from 12 lead ECG tracings by applying 12 different algorithms in pediatric patients diagnosed with Wolff-Parkinson-White syndrome. We compared algorithm accuracy in electrophysiologic study ECG tracings with full preexcitation and resting ECG tracings. The assessing pediatric cardiologists were blinded regarding EP study results on AP localization. For exact AP location, the algorithms published by D’Avila et al. and Boersma et al. yielded the highest accuracy (58%). Distinguishing laterality, the median accuracy for predicting left or right-sided APs was 74%, while for septal APs it was 68%. We conclude that algorithms predicting AP location in pediatric patients with Wolff-Parkinson-White syndrome show low accuracy for exact AP localization. For laterality, however, accuracy was significantly higher.