RESUMEN
OBJECTIVE: To determine the incidence of cardiovascular collapse in children receiving intravenous (IV) amiodarone and to identify the population at risk. DESIGN: A multicenter study of patients ≤ 18 years of age who received intravenous amiodarone between January 2005 and December 2015. A retrospective analysis was performed to identify patients who developed cardiovascular collapse (bradycardia and/or hypotension). RESULTS: Of 456 patients who received amiodarone, cardiovascular collapse occurred in 47 patients (10%). Patient risk factors for collapse in a univariate analysis were as follows: age < 3 months (p = 0.04), depressed cardiac function (p < 0.001), blood pressure below 3rd percentile (p < 0.001), high lactate at baseline (p < 0.001). Administration risk factors included bolus administration (p = 0.04), and bolus administration over ≤ 20 min (p = 0.04). In multivariate analysis, age, baseline blood pressure less than 3rd percentile, and rapid bolus delivery were independent risk factors for cardiovascular collapse in the study group. The mortality rate was significantly higher in the collapse group (28% versus 8%). CONCLUSION: We found an association between IV amiodarone administration and the risk of developing cardiovascular collapse in a significant subset of children. Extreme caution and careful hemodynamic monitoring is recommended when using IV amiodarone in this population, especially in young infants, hemodynamically compromised patients, and in patients receiving rapid amiodarone bolus administration.
Asunto(s)
Amiodarona/efectos adversos , Antiarrítmicos/efectos adversos , Bradicardia/inducido químicamente , Hipotensión/inducido químicamente , Taquicardia Ectópica de Unión/inducido químicamente , Taquicardia Ventricular/inducido químicamente , Administración Intravenosa , Adolescente , Distribución por Edad , Amiodarona/administración & dosificación , Amiodarona/farmacología , Antiarrítmicos/farmacología , Antiarrítmicos/uso terapéutico , Presión Sanguínea/efectos de los fármacos , Bradicardia/mortalidad , Niño , Preescolar , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipotensión/mortalidad , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Taquicardia Ectópica de Unión/mortalidad , Taquicardia Ventricular/mortalidadRESUMEN
A 51-year-old woman with relapsing-remitting multiple sclerosis was initiated on fingolimod. She developed a Mobitz Type I (Wenckebach)second-degree atrioventricular (AV) heart block during the initial 6-hour monitoring. She was transferred to the emergency department for further monitoring, where she went into a junctional tachycardia then went back into a Mobitz Type I AV block. The patient was symptomatic with a heart rate nadir of 38 beats per minute and treated with atropine. Junctional tachycardia has not been previously reported with fingolimod use. Patients may require extended cardiac monitoring after fingolimod administration.
Asunto(s)
Bloqueo Atrioventricular/inducido químicamente , Inmunosupresores/efectos adversos , Glicoles de Propileno/efectos adversos , Esfingosina/análogos & derivados , Taquicardia Ectópica de Unión/inducido químicamente , Bloqueo Atrioventricular/diagnóstico , Femenino , Clorhidrato de Fingolimod , Humanos , Persona de Mediana Edad , Esfingosina/efectos adversos , Taquicardia Ectópica de Unión/diagnóstico , Factores de TiempoAsunto(s)
Bloqueo Atrioventricular , Cardiomiopatía Dilatada , Glicósidos Digitálicos/toxicidad , Electrocardiografía , Taquicardia Atrial Ectópica , Taquicardia Ectópica de Unión , Bloqueo Atrioventricular/inducido químicamente , Bloqueo Atrioventricular/fisiopatología , Cardiomiopatía Dilatada/inducido químicamente , Cardiomiopatía Dilatada/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Taquicardia Atrial Ectópica/inducido químicamente , Taquicardia Atrial Ectópica/fisiopatología , Taquicardia Ectópica de Unión/inducido químicamente , Taquicardia Ectópica de Unión/fisiopatologíaAsunto(s)
Bloqueo de Rama/complicaciones , Bloqueo de Rama/diagnóstico , Cardiotónicos/envenenamiento , Digoxina/envenenamiento , Electrocardiografía , Taquicardia Ectópica de Unión/inducido químicamente , Taquicardia Ectópica de Unión/diagnóstico , Complejos Prematuros Ventriculares/inducido químicamente , Complejos Prematuros Ventriculares/diagnóstico , Anciano , Diagnóstico Diferencial , Humanos , Masculino , Debilidad Muscular/etiología , Taquicardia Ectópica de Unión/complicaciones , Complejos Prematuros Ventriculares/complicacionesAsunto(s)
Antiarrítmicos/efectos adversos , Taquicardia Ectópica de Unión/inducido químicamente , Verapamilo/efectos adversos , Anciano , Antiarrítmicos/administración & dosificación , Diagnóstico Diferencial , Electrocardiografía , Femenino , Humanos , Taquicardia Ectópica de Unión/diagnóstico , Verapamilo/administración & dosificaciónRESUMEN
In a patient with WPW syndrome and idiopathic dilated cardiomyopathy, intractable atrioventricular reentrant tachycardia (AVRT) was iatrogenically induced. QRS without preexcitation, caused by junctional escape beats after verapamil or unidirectional antegrade block of accessory pathway after catheter ablation, established frequent AVRT attack.
Asunto(s)
Antiarrítmicos/efectos adversos , Cardiomiopatía Dilatada/cirugía , Ablación por Catéter/efectos adversos , Taquicardia por Reentrada en el Nodo Atrioventricular/etiología , Verapamilo/efectos adversos , Síndrome de Wolff-Parkinson-White/cirugía , Adulto , Cardiomiopatía Dilatada/tratamiento farmacológico , Electrocardiografía , Humanos , Enfermedad Iatrogénica , Masculino , Taquicardia por Reentrada en el Nodo Atrioventricular/inducido químicamente , Taquicardia Ectópica de Unión/inducido químicamente , Taquicardia Ectópica de Unión/etiología , Síndrome de Wolff-Parkinson-White/tratamiento farmacológicoRESUMEN
A patient is reported who developed a marked prolongation of QTc and life threatening ventricular arrhythmias during oral Ketanserin therapy. No other factors contributing to the QTc prolongation or to the occurrence of ventricular arrhythmias were found. The relevant literature is reviewed.
Asunto(s)
Arritmias Cardíacas/inducido químicamente , Ketanserina/efectos adversos , Síndrome de QT Prolongado/inducido químicamente , Taquicardia Ectópica de Unión/inducido químicamente , Taquicardia Supraventricular/inducido químicamente , Administración Oral , Anciano , Electrocardiografía , Humanos , Ketanserina/administración & dosificación , Síndrome de QT Prolongado/fisiopatología , Masculino , Taquicardia Ectópica de Unión/fisiopatologíaRESUMEN
A variety of acute supraventricular tachycardias may be encountered. In many instances the therapies for these rhythm disturbances overlap, but a rational approach to individual disturbances should be based on an understanding of the anatomy and physiology involved in the individual dysrhythmia. Numerous investigative approaches are underway at present, especially with regard to interruption of arrhythmia pathways by electroshock therapy or surgical therapy. In addition, pacing overdrive may be very effective, especially in patients with reentrant arrhythmias.