RESUMO
Atrioventricular reentrant tachycardia (AVRT) is the most common cause of supraventricular tachycardia in young children. In nearly 70% of cases, there is manifest preexcitation on electrocardiogram. In the rest, the accessory pathway is concealed. Drugs control AVRT by affecting conduction through the atrioventricular node (beta-blockers, digoxin, verapamil) or accessory pathway (flecainide, propafenone) or both (sotalol, amiodarone). Adenosine is the drug of choice in acute management of AVRT in hemodynamically stable children. In adenosine-resistant cases, intravenous flecainide, procainamide, esmolol, propafenone and amiodarone are other treatment options. Hypotension and bradycardia can occur during administration of these drugs. Verapamil may be used to treat AVRT using a concealed pathway. Verapamil should be avoided in infants and in patients with decreased cardiac function. In chronic management, catheter ablation is the preferred treatment in older children with frequent AVRT. In infants and small children, ablation is associated with higher risk, and pharmacologic management is recommended. Beta-blockers are the preferred first line drugs for chronic management. In patients with concealed accessory pathway, digoxin and calcium channel blockers are alternative options. Sotalol, flecainide, propafenone and amiodarone can be prescribed in resistant cases. Flecainide and propafenone should be avoided in children with structurally abnormal hearts because of a higher risk of proarrhythmia. The initiation of flecainide, propafenone and sotalol therapy is recommended in an inpatient setting to monitor for proarrhythmias.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Antiarrítmicos/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Taquicardia por Reentrada no Nó Atrioventricular/tratamento farmacológico , Doença Aguda , Ablação por Cateter , Criança , Doença Crônica , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/classificação , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Síndrome de Wolff-Parkinson-White/tratamento farmacológicoRESUMO
BACKGROUND: Carvedilol reduces mortality and hospitalization in adults with congestive heart failure. Limited information is available about its use in children. METHODS: We reviewed the medical records of 24 children with dilated cardiomyopathy and left ventricular ejection fraction of Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico
, Antagonistas Adrenérgicos beta/uso terapêutico
, Carbazóis/uso terapêutico
, Cardiomiopatia Dilatada/tratamento farmacológico
, Propanolaminas/uso terapêutico
, Adolescente
, Antagonistas Adrenérgicos alfa/administração & dosagem
, Antagonistas Adrenérgicos alfa/efeitos adversos
, Antagonistas Adrenérgicos beta/administração & dosagem
, Antagonistas Adrenérgicos beta/efeitos adversos
, Carbazóis/administração & dosagem
, Carbazóis/efeitos adversos
, Cardiomiopatia Dilatada/fisiopatologia
, Carvedilol
, Criança
, Pré-Escolar
, Quimioterapia Combinada
, Feminino
, Humanos
, Masculino
, Propanolaminas/administração & dosagem
, Propanolaminas/efeitos adversos
, Volume Sistólico
, Resultado do Tratamento