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Adjunctive ivabradine in combination with amiodarone: A novel therapy for pediatric congenital junctional ectopic tachycardia.
Heart Rhythm 2016; 13(6):1297-302HR

Abstract

BACKGROUND

Treatment of congenital junctional ectopic tachycardia (JET) is often challenging. In the majority of patients affected, a combination of ≥2 antiarrhythmic drugs is required for JET control.

OBJECTIVE

The purpose of this study was to assess the efficacy and safety of adjunctive ivabradine therapy for pediatric congenital JET.

METHODS

Since January 2015, 5 consecutive patients aged 10 days to 3.5 years (median 8 weeks) were treated with adjunctive ivabradine for congenital JET. All patients had previously undergone antiarrhythmic therapy with unsatisfactory control of JET. Ivabradine was administered orally at an initial dosage of 0.05-0.1 mg/kg/d divided into 2 single doses and was increased up to 0.28 mg/kg/d if necessary.

RESULTS

In all 5 patients, ivabradine proved to be successful in controlling JET. Complete suppression of JET and conversion into sinus rhythm were achieved in 4 of 5 patients. The remaining patient had effective heart rate control with persistent slow JET. Mean heart rate was reduced by 31% compared to pre-ivabradine (P = .03) as assessed by 24-hour Holter monitoring. Echocardiography revealed improvement of left ventricular function in all 3 patients with previously impaired left ventricular function. No significant side effects of ivabradine were encountered during median follow-up of 135 days (range 37-203 days).

CONCLUSION

In our group of patients with congenital JET, adjunctive treatment with ivabradine resulted in effective and safe rhythm/heart rate control and therefore may be recommended early in the course of this rare inborn tachyarrhythmia.

Authors+Show Affiliations

Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany. Electronic address: jana.dieks@med.uni-goettingen.de.Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27216242

Citation

Dieks, Jana-Katharina, et al. "Adjunctive Ivabradine in Combination With Amiodarone: a Novel Therapy for Pediatric Congenital Junctional Ectopic Tachycardia." Heart Rhythm, vol. 13, no. 6, 2016, pp. 1297-302.
Dieks JK, Klehs S, Müller MJ, et al. Adjunctive ivabradine in combination with amiodarone: A novel therapy for pediatric congenital junctional ectopic tachycardia. Heart Rhythm. 2016;13(6):1297-302.
Dieks, J. K., Klehs, S., Müller, M. J., Paul, T., & Krause, U. (2016). Adjunctive ivabradine in combination with amiodarone: A novel therapy for pediatric congenital junctional ectopic tachycardia. Heart Rhythm, 13(6), pp. 1297-302. doi:10.1016/j.hrthm.2016.03.015.
Dieks JK, et al. Adjunctive Ivabradine in Combination With Amiodarone: a Novel Therapy for Pediatric Congenital Junctional Ectopic Tachycardia. Heart Rhythm. 2016;13(6):1297-302. PubMed PMID: 27216242.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Adjunctive ivabradine in combination with amiodarone: A novel therapy for pediatric congenital junctional ectopic tachycardia. AU - Dieks,Jana-Katharina, AU - Klehs,Sophia, AU - Müller,Matthias J, AU - Paul,Thomas, AU - Krause,Ulrich, PY - 2015/11/26/received PY - 2016/5/25/entrez PY - 2016/5/25/pubmed PY - 2018/1/18/medline KW - Arrhythmia KW - Children KW - Congenital junctional ectopic tachycardia KW - Ivabradine SP - 1297 EP - 302 JF - Heart rhythm JO - Heart Rhythm VL - 13 IS - 6 N2 - BACKGROUND: Treatment of congenital junctional ectopic tachycardia (JET) is often challenging. In the majority of patients affected, a combination of ≥2 antiarrhythmic drugs is required for JET control. OBJECTIVE: The purpose of this study was to assess the efficacy and safety of adjunctive ivabradine therapy for pediatric congenital JET. METHODS: Since January 2015, 5 consecutive patients aged 10 days to 3.5 years (median 8 weeks) were treated with adjunctive ivabradine for congenital JET. All patients had previously undergone antiarrhythmic therapy with unsatisfactory control of JET. Ivabradine was administered orally at an initial dosage of 0.05-0.1 mg/kg/d divided into 2 single doses and was increased up to 0.28 mg/kg/d if necessary. RESULTS: In all 5 patients, ivabradine proved to be successful in controlling JET. Complete suppression of JET and conversion into sinus rhythm were achieved in 4 of 5 patients. The remaining patient had effective heart rate control with persistent slow JET. Mean heart rate was reduced by 31% compared to pre-ivabradine (P = .03) as assessed by 24-hour Holter monitoring. Echocardiography revealed improvement of left ventricular function in all 3 patients with previously impaired left ventricular function. No significant side effects of ivabradine were encountered during median follow-up of 135 days (range 37-203 days). CONCLUSION: In our group of patients with congenital JET, adjunctive treatment with ivabradine resulted in effective and safe rhythm/heart rate control and therefore may be recommended early in the course of this rare inborn tachyarrhythmia. SN - 1556-3871 UR - https://www.unboundmedicine.com/medline/citation/27216242/Adjunctive_ivabradine_in_combination_with_amiodarone:_A_novel_therapy_for_pediatric_congenital_junctional_ectopic_tachycardia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1547-5271(16)30016-9 DB - PRIME DP - Unbound Medicine ER -